Pregnancy as casino...

One of the many differences between Puerto Rico and the United States is the way in which they handle healthcare and, in particular, pregnancy.

Our first run at this was in the Caribbean, along with the lengthy waits and monotonous ramblings of other patients trying to simultaneously hide and reveal their illnesses, you get a very personal attention. Doctors are quite involved and more concerned with the overall happiness of the patient. They frequently have an ultrasound room for frequent use by the mother-to-be and they have a listening station where one might pop in and quickly listen for your baby when scared witless by your mother's thoughtless commentary.

Our experiences in Boston have been quite different. First of all, appointments have the worrying tendency of starting on time. If they say '9am' - you should be there before 9am to sign in and be ready. We have had some difficulty in getting used to the business-like manner in which our visits are conducted. Nurse - walks in, pleasantries (no more than 15 secs), take temp, take blood pressure, few words of encouragement (no more than 30), out. Three to four minute wait. Doctor - in, quick demonstration that they know the case, read results from nurse, nod and smile (v. important), inquire if I am the husband (without any mention that I am not white), move right along.

We're getting a little more used to the treatment and quite frankly I can do without all the typical Indian bulls^*t that you get at Dr. Rampal's surgery back in London. First there is the passive aggressive secretary, Snay (who I think I am related to), who inquires after everyone in your family while shaking her head and clucking like a mother hen. Then you have to deal with the semi-diagnostic process when you are sure the doctor is paying very little attention to your symptoms and is likely to prescribe you something that involves putting your finger in your anus.

Our latest installment came just before our announcement to all of you and actually forced us to leave behind our fears and accept that there was a fairly good chance we were going to make it through this pregnancy. There is a procedure, the Early Risk Assessment (ERA), that alerts you to the risks of your baby having any chromosomal deficiencies which could lead to things like Down Syndrome etc. It comes in two parts, the first is bloodwork (easy enough), the second is a hyper precise ultrasound where they look for two physical characteristics - the presence of the nasal bone AND the size of a pool of fluid that can be found at the base of the neck. If the fluid is less than 3mm wide, we're all good... if more, we have a slightly elevated chance of some problems...

Our technician led us to a nice, soothing beige room where she described the process quite extensively. At this point, Eileen and I experienced something I like to call - 'sonically induced elevated blood pressure'. Between spasms of fearful hand-wringing, we asked a few questions and resigned ourselves to proceed.

Firstly, she asked us for a full family history. She worked up a gene-tree to map any problems we might have in the families. Aside from the obvious heart and cholesterol issues, we seemed fine. Both Eileen and I seemed worried by the lack of ink on the page and our competitive streaks were awakened. Firstly, with some hesitation and then with gusto, we began to spit out issues which we thought might shed light on our imagined issues:
- my father's mother has hearing problems...
- my mother's sister is really quite tense...
- my brother is militantly argumentative...
Peculiarly, none of these symptoms seem to interest our technician.

I soon learned what I am going to be like at little league games - it was quite embarrassing.
The sonogram began and we stared closely at the screen looking for a nose and an unoffending pool of liquid on the child's neck. The tech worked her magic and looked at us closely.
"You guys should relax, you know."
"Oh yeah, we're fine."we both stammered, trying to seem less tense.
"It's going to be fine." she assured us.
We continued to watch in silence while she jiggled and fiddled with the device. Finally, she moved in on AP's face and froze the picture.
"Okay, mom and dad, that is junior's face with a very pronounced nasal bone!" she smiled.
I leapt out of my chair and screamed. "Oh yeah, that's right!"
The two ladies were cringing in terror at my outburst. I didn't seem to care as I kissed the monitor.

The search for the liquid was fine as well (we were in the middle of the sweet spot, 1.8mm) and our results give AP a fairly good outlook as we progress toward the big day. The odds jumped twenty fold in our favor - better than a rigged game of blackjack.

And if our fear-mongering technician ever reads this - suck on that, Sally !!!