The power of what we do and don't talk about

Yesterday was our 26th wedding anniversary.  As happens on days like that, Tony and I were reflecting on our past, and especially on my pregnancy with my first child, William. 

Then in the early 90s even more than now, it seemed like pregnancy complications were something not to be talked about.  It was the heyday of "What to Expect When You're Expecting", a book that seemed determined to let you know that everything you were experiencing was just fine, perfectly normal.  There were a few small pages only about what can actually go wrong, and they were presented as something you probably didn't even need to know about, something you certainly shouldn't dwell on.  And so when my pregnancy felt different than what I read about or saw around me, I figured I was just being paranoid. 

I wasn't, and William was born at 7 months by emergency C-section because my pre-eclampsia had progressed to life-threatening levels.  It turned out, in my family anyway, that wasn't that uncommon.  On my father's side in particular, pre-eclampsia turned up often, with the strongest example being my great-grandmother, who died of eclampsia, seizures, a few days after my grandmother was born.  A few months after William's birth, the TV series ER had an episode called "Love's Labor Lost", in which a mother dies from complications of pre-eclampsia.  I wish I'd seen it sooner, although it was the hardest thing to watch I've ever seen.

A scene from ER's "Love's Labor Lost"

Of course, there are reasons we don't talk about everything in our lives publicly.  There is much in all our lives, including mine, that we don't share.  The reasons are many, and sharing or not is a choice we have a right to make, and sometimes an obligation to make.

However, at times, sharing can be life saving, or soul saving.  My life, and William's, were in the balance around the time of his birth.  I wish I had known what I know now about how suddenly and drastically pregnancy can take a turn.  And when it comes to my life with Janey---if I hadn't found the people I have, through this blog, mainly, I don't know if I would be here today.  There were days, and nights, that were only survivable by knowing that others had lived this life and gone on to a place of calm, even happiness.  And what keeps me writing today is those letters I've gotten from others with girls like Janey telling me how knowing they weren't alone kept them going.

Something I try to always keep in mind, though, is that there is much we don't know about the lives of others.  We don't always know what others are struggling with, what health issues or family issues or any other issues are affecting their lives.  There are many things we don't share, or aren't ready to share.  There are many times we are the ones depending on others who ARE ready, who DO share, whose stories we cling to as we struggle with what we ourselves are not yet, or ever, sharing.  Help comes in many forms---both in how we give and how we get help.

I want to thank those who have made me know I'm not alone, over the years---both those who shared their life experiences and those who didn't, but used them to become comforters and helpers of others.  May none of us ever feel truly alone.

On Not Following the Script

I had a dream last night (and I feel compelled to say to my dear friend Julie, as I always do when talking about dreams, that she is free to skip this reading, as she hates to hear about people's dreams) about being in an English class.  The teacher had asked me to write a script, a short play, and I had spent the whole weekend doing that.  In the class on Monday, the teacher was supposed to have the class read through the play.  However, he didn't---he did something totally different in class.  I got upset, and yelled at him, screamed he wasn't doing as he said he would do.  I acted in a way I don't act, except in dreams---I spoke up loudly and told him how angry I was.

I do think most dreams are random, but in reflecting on that dream this morning, I saw something I recognized.  I was taken back to another time in my life that, as now, the normal script seemed to have been completely abandoned, replaced by what feels like a horrible ad lib.

When I was pregnant with my first child, I avidly read everything I could find about pregnancy and childbirth.  I love to read, and I had a faith that everything I could need to know was contained in books.  At that point, the most popular book around was "What to Expect When You're Expecting".  It had a firm tone.  It told exactly how things were supposed to go, how you were supposed to act and eat and exercise.  Once in a while, it had off-hand mentions of rare, rare exotic and vaguely shameful things that could go wrong, but they were stressed as the exceptions.  I liked that.  I was going to do everything right.

Well, it didn't work out that way.  William was born at 7 months, weighing three and a half pounds.  I had developed severe pre-eclampsia, and his life and mine were at stake.  I could have easily died, taking him with me, just as I learned had happened long ago to my great-grandmother, while giving birth to my grandmother.  We found her death certificate online, showing she died of eclampsia the day after having my grandmother.  Thankfully, modern medicine kept William and me alive, but I was thrown into the world of parenting outside the script in a most stunning and abrupt way.

Many things with this current situation feel like 20 years ago.  Then as now, I had a child held in a hospital, one I could only see by visiting.  Then as now, before we visited, we were supposed to call nurses to make sure it was a good time.  Then as now, the visits took a drive---then through crazy Boston streets, now south down a long highway.  Then as now, it felt like I had left some script, that was ad-libbing, doing improv, living without a map.

I think one of the very hardest parts about parenting a child like Janey is that we feel so outside the script.  Ten year old girls are supposed to be in 5th grade, getting ready for junior high.  They are supposed to go to sleepovers.  They are starting to make the friends that will remain friends for life.  They are reading books like the Little House series.  They might keep diaries, or play sports, or collect a certain toy avidly.  I remember being 10.  Ten was the start of life in a lot of ways.  Ten year olds are not supposed to be in locked psychiatric wards because they were hurting themselves and others.  They are not supposed to be talking mostly in movie quotes.  They are not supposed to be non-toilet trained.  The script has been completely abandoned.

And yet, I am finding, as I get older, that almost nobody follows the script exactly.  Almost everyone you truly get to know has parts of their life that are off-script.  Some had a childhood of horrors they are still processing.  Some have lost children in heartbreaking ways.  Some have their own illnesses, mental or physical, which take a huge toll.  Almost everyone lives a life that in some way doesn't fit into the confines of the cheery, authoritative tone of the What to Expect books.

It's the scariest part of life knowing that there really isn't a script.  But there is comfort in knowing, for me, that it's the same for everyone. We all muddle through to some extent, and the best we can do is keep on ad-libbing to the end.

Okay, Scientists, You Got Me Again!

Once in a while, I have a sneaking suspicion that autism researchers are messing with me.  I think they get together and say "Okay, let's pull up Suzanne's medical history and that of her family, look at everyplace she has lived and all the circumstances of her pregnancies and childbirths.  We'll pick something new from all of that this month to release as a possible cause of autism.  Wait 'til we see the look on her face!"  Of course, I'm not truly that paranoid or self-centered, but sometimes it's amazing how many potential causes of autism would work for me.

The newest is iron intake.  I have almost always tested as anemic, and that was very much the case during all my pregnancies.  With Janey, it was exasperated by the fact that the iron I was taking seemed to interfere with my thyroid medication.  Because having a thyroid basically not working was considered much more dangerous than having a low iron count, for the last half of the pregnancy, I didn't take iron.  I tried hard to eat a lot of red meat (despite popular belief, I was told it's a far better source of iron than green vegetables), but still, my iron remained low.  So there's another reason for Janey's autism!  It joins a nice long list, including the low thyroid itself, a family history of autoimmune disorders, my allergic reaction to Aldomet at 12 weeks pregnancy, the fact I live near a major street, several possibly on the spectrum people in Tony's family and mine, Tony being an older father, my living my first 6 years near Lake Eire at its most polluted with PCBs, preeclampsia during my pregnancy, birth trauma (Janey's umbilical cord was around her neck twice)....that's just the ones I can think of easily off the top of my head.

Those scientists missed the boat with ONE potential cause I saw the news today---having children very close together.  However, I'm not out of the woods with that one, because if you wait TOO long to have a child, over 5 years (there is 7 years between Janey and Freddy, exactly), the risk of autism again rises by 30%.

What do I do with all this?  Not much.  There isn't anything I can change from the past, and I'm certainly not planning on having any more children---I'm 48.  I am glad research is being done, but all joking aside, the fact that so many of the factor apply to me is probably the case with many parents of autistic kids.  There are so many potential reasons thrown out there that I couldn't imagine being a pregnant woman trying to avoid all of them.  There's just too many.  I think about this in terms of my sons someday.  If they become fathers, there were certainly right off the bat be an increased risk of them having a child with autism, and I feel for their future wives thinking about them trying to avoid any further risk.

Do I sometimes feel guilty about all the risk factors that might have affected Janey?  Of course I do.  I know I shouldn't, but guilt isn't a logical emotion.  I don't obsess over it, but I think about it.  I get angry about a few of them, especially the Aldomet reaction.  I wonder if I should have had a C-section---if a good ultrasound could have seen the cord around Janey's neck.  I worry I didn't do enough to keep my iron up.  I have other worries, the kind that suddenly hit you in the middle of the night and aren't logical, but the middle of the night brain isn't good at logic.

I hope some day, all the possible causes of autism are narrowed down, or at least better defined, so that knowledge of them can be incorporated into prenatal care and PREprenatal planning.  I suspect, though, that no matter what, we'll never totally have answers about autism's cause.  I hope society will do its very best to support the children that, despite all the research, still develop autism.

Randomness

Lately, for some reason, I've been thinking a lot about how random events affect lives.  If I hadn't happened to look in the paper the day I found the job that led me to meet my husband, I probably never would have met him.  If I hadn't happen to take the bad step out of my parent's travel trailer back years ago, I wouldn't have broken my leg.  And, through a combination of factors that are not all certain, but that lined up in a certain way, I have a daughter with autism.

I think most people have a feeling deep inside them, until something happens to change it, that their lives are somehow charmed---that they do things right, and because of that, life is not going to deal them surprises they aren't ready for.  I know I felt that way, anyway, until my first pregnancy went badly wrong and I wound up having an emergency C-section and being inches from losing working kidneys, feet from dying.  For a while after that, everything felt uncertain.  I realized that I had no special dispensation from life's tougher dealings.  Anything could happen to me.

After a while, once you realize that you are not untouchable, you stop thinking about it as much.  But I don't think you are ever quite the same.  You are never quite as surprised when things go awry, for reasons outside your control.  Janey having autism was not something I anticipated, but somehow, I don't think it totally blindsided me either.  I knew it could happen, because I knew anything could happen.

Why am I writing about this?  It's because I think sometimes the people that don't get having a special needs child, and to put it more broadly, the people that don't believe in helping others down on their luck, are people that have never had that experience that makes them realize that they too could be in the shoes of those "others"  If you truly feel you have control over what happens to you in life, it makes sense to oppose funds to help those with children with special needs, or those who wind up without a job or a way to feed their children, or those who lose their homes in disasters or their sanity to mental illness.

I think sometimes of the reception Janey gets in different kinds of places.  Almost always, the toughest places to take Janey are places where I think the percentage of people with lives untouched by true unexpected hardship is high---fancy stores, upscale streets, hushed cultural events, vaulted academic settings.  I am in no way saying there aren't people in these places with lives that are far more troubled than I can ever know, but there are less of them, I think.  When I take Janey to the convenience store near our house, I almost always get smiles, kind words, understanding looks.  It happens too often to be chance.  The people there often look as if life has been tough for them.  But they seem to get Janey---to at least get what it's like to have a child or to be a child with special needs.  It's a pattern I see a lot.  The people that embrace Janey, and embrace our family, have for some reason been through tough, unexpected times.  They have been hit by life's randomness.

A long time ago, when Tony and I were first married, we stayed at a hotel where in the room across from us, a child screamed all night.  I hope we weren't uncaring as to the plight of the child or the parents, but I don't remember thinking "those poor people!  That poor kid!"  Tony and I think of that child a lot now.  I have heard that screaming now, from my precious Janey, so often.  I feel quite sure the child was autistic.  I wish sometimes I could go back in time and somehow help those people, instead of feeling annoyed and wishing they weren't there, as I did at the time.

I wish I could believe things happen for a reason.  But I don't believe that.  I believe life is pretty random.  But we can choose how we react to the randomness, and we can ease each other's way, because someday, we ourselves might be the randomly chosen one.

Thankful

Today is Thanksgiving Day in the US, and I am indeed feeling thankful.  Here's some of the reasons why---

1.  I live in the right time in history.  In the past, Janey would not be able to go to school.  We would have been blamed for her autism, or we would have been told to put her away and forget her.  Or worse.  Nothing is perfect, but I think of all the historical eras I could be living in, I've hit the jackpot with today's world.

2.  I have a wonderful husband.  Tony, I couldn't do it without you.  Literally.  I think I'd be dead by now.  You are there when Janey wakes 10 times a night, when she screams for hours, when she cries for days.  You are there for the good times, too.  You make her bacon whether she eats it or not, just because she likes the process.  You sing with her, recite Three Stooges with her, delight in her good moods.  You are amazing.

3.  By twists of luck too improbable to seem like sheer chance, Janey is attending exactly the school I would have dreampt up for her, had I been dreaming up a school in my head.  The Henderson Inclusion School is something I am extremely, overwhelmingly thankful for.

4.  Janey has two amazing brothers, terrific young men who love their sister, who help me with her, who have fun with her and just treat her like a sister should be treated, with teasing and laughing and fun.

5.  I am so thankful for music, and for Janey's love of it.  The whole day is often filled with song, surprise tracks of pieces she's heard long ago and old favorites mixed together to make a medley I love to hear.

6.  Modern medicine.  I have all the questions and concerns and worries about it that most of you probably share, but when it comes down to it, I wouldn't be here to have those concerns without it.  I'd have died long ago from preeclampsia when pregnant with William.  Tony wouldn't be here without insulin.  Freddy would be here without the magnesium sulfate and skilled care that got him through a potentially deadly asthma attack as he turned eleven.  And Janey, without the medications I love to hate and hate to love, would not be able to be making the strides she is, I do believe.

7.  All of you, and the internet that allows us to connect.  Even twenty years ago, I would be alone in this all, maybe having met one or two other families ever with autistic girls.  Today, I can reach out and talk to many, many people about this tough journey, people that understand and have been there.  That's pretty darn amazing.

8.  And of course, I am thankful for Janey herself.  Janey, you are one terrific girl.  You are beautiful, fascinating, mysterious and so often, a joy.  You have brought me many challenges, but you yourself, you amazing girl, you make it all worth while.  I love you, Janey.

What Made Janey Autistic #2 in a series

I want to say before I start this entry that I am not a doctor, obviously, and I am using medical ideas to write this that I have remembered along the way.  Please don't take them for hard facts, as they could be wrong!  What I'm trying to do here is give my thoughts based on what I've read and heard, which is I think what we all try to do with figuring out this autism bit!

That said, my theory #2 of what caused Janey's autism is that autism is an autoimmune disease, and our family is for some reason heavily prone to autoimmune diseases.  As I understand it, an autoimmune disease is one in which the body's own defense mechanisms get overactive and attack the body they are supposed to be protecting.  The idea is that something triggers the body to start attacking the brain at some point, causing autism.  It could be some little sickness we can't even remember the child having, or some other trigger that is impossible to figure out.

Our family tree is full of examples of diseases that are at least in part autoimmune.  I have a pretty much non-functioning thyroid and have to take large doses of thyroid replacement every day.  I also have asthma.  When I was pregnant with 2 of my 3 kids, I had pre-eclampsia, which is thought to be another AID (auto-immune disorder, so I don't have to keep writing it!)  Tony is an insulin-dependent diabetic, a type that is kind of a cross between type one and type 2.  Freddy has asthma like me.  My mother has Raynaud's Disease.  My sister, my mother, Freddy and myself all have pretty severe seasonal allergies.  My sister had thyroid cancer.  My uncle and grandmother had or have disfunctional thyroids, like myself.  Almost everyone in Tony's family has the same kind of diabetes he does---his brothers, his father and many aunts and uncles and cousins.  The list could go on and on.  We are poster kids for AID.

One, someplace, I read that another sign of being prone to AID is when the MMR vaccine doesn't take as a child.  Both my sister Carrie and I were tested when we were at child-bearing ages, and were found to be not immune to rubella, and had to have another shot.  Our immune system fought off even the vaccine dose as kids, and didn't therefore get the immunity.

The AID-autism connection just makes sense to me.  You aren't born with AID.  Something triggers them.  That would explain why kids develop autism as they get exposed to more things in the environment.  Some people are pre-disposed to AID---not every kid is going to be triggered to be autistic.

A weird thing that also seems like a connection to me is how rarely Janey gets sick.  She doesn't get the colds or flus or viruses that go through her classes.  She's missed almost no school days due to illness in years.  William, who was originally also thought to be on the spectrum, is the same way.  Freddy gets everything that goes down the pike and more, so it's not just a family trait to not get sick.  I think Janey's immune system is overactive.  She gets rid of any illness that comes around, and does so overactively.  I can see how at one point, something might have triggered her body to go all out on attack, and mistakenly went for her brain, too.

As with the pregnancy/fever/flu theory, the AID theory could easily explain Janey's autism.  I wish it were the last thing that could, but there's more!  #3 in this series is coming soon.

Okay, another check on the checklist

The latest news from the world of autism? Fever during pregnancy can double the risk of autism. Here's an article. Lovely. Another way I caused Janey's autism. It's like I went into the future, found a list of all the ways they were going to decide autism could be caused, made up a checklist and tried to hit them all. If there was something called double autism, she'd probably have that, I hit so many of those checkmarks.

The fever I had, at 12 weeks, was pretty severe. It was caused by my reaction to Aldomet, which I was put on due to getting preeclampsia (high blood pressure and other problems) early in my pregnancy. Of course, preeclampsia is another risk factor recently discovered for autism. Of course.

I can't wish they wouldn't discover all this stuff. I want to help other mothers-to-be. And I know that I certainly didn't MEAN to put Janey at risk for autism. I would have done ANYTHING during my pregnancy to avoid it, if I had known. But I didn't. Nor did Tony, who was an older father, one of the rare instances where fathers can join in the guilt parade. I didn't know another medication I was taking, which I repeatedly asked my OB if I should stop taking, would later to said to be another possible cause.

I know it doesn't do a bit of good for me, or for Janey, to get upset over all this. I don't have a time machine. I can't change anything. And I should feel happy for others, who might not have a child with autism due to all the recent discoveries. But of course, I feel guilty. That's what mothers do.

What causes autism? And does it matter?

Well, of course it does matter, but by that, I mean does it matter to children and families already living with autism? It certainly matters to those future children who could potentially be prevented from becoming autistic if we knew what was causing it, but in a lot of ways, it doesn't matter much to Janey, or to me, in terms of our day to day life.

That's not to say I don't wonder, but I can't say I think a huge amount about it. That's been hard lately, as every single day, it seems, there's a new article out there with a new potential cause. They can't all be right, or maybe they can---I do think autism is caused in different ways in different kids, and they might ALL be a cause. But that leaves more answers than questions if it's true---which one caused MY child's autism? And it opens up the feeling that I think probably almost all parents of a child with autism have had---"it's my fault somehow" I know rationally it isn't. I don't take the credit for Janey being so beautiful, or my sons being quite the bright guys, or for William being musical or Freddy being a good actor. I don't take the blame for Freddy's health issues or any character flaws either of them might or might not have. So it stands to reason I shouldn't take the blame for Janey's autism, and in general, I choose not to.

But the list goes on---genetics, vaccines, older fathers, close spacing between children, overweight mothers, medication taken during pregnancy, mercury, thyroid problems during pregnancy, pre-eclampsia, ultrasounds, low birth weight, lack of oxygen at birth, diet, autoimmune disease, viral infections, brain defects, rain, too much TV, Tylenol...well, a huge amount of things. A fair amount of the list applies to Janey, making me think it would probably have been more of a surprise had she NOT been autistic, almost. But of course that's not the way to think, and it shows the problems with a lot of those theories---why don't ALL kids with those risk factor become autistic? Obviously there must be more than one factor at work in most cases.

If I personally had to guess about the cause of Janey's autism, at the current time I'd put three factors in the most likely list. First is the autoimmune disorder idea. Almost everyone on either side of our family has some kind of autoimmune problem. This goes along with factor two--preeclampsia. I was severely affected by this during my first pregnancy, and was to a fair extent while pregnant with Janey. My third thought is the severe reaction I had to a blood pressure medication I was given at 12 weeks while pregnant with Janey. These three factors all tie together. But who knows, really? I think most of autism is probably like that---caused by an interaction of factors. This is why I try never to get into the fray of arguments about what causes autism. I think everyone is right and everyone is wrong. Some cases of autism probably are caused by vaccines. Some are caused by genetics, some by birth injury. Most by a mix and match list of many factors.

But the end result, no matter how you get there, is autism. It's like the stupid Holland story. No matter why you ended up in Holland instead of in whatever country you were aiming for, you're still in Holland. I'm content to let the research and battle over what caused Janey's autism fight on without me joining in. My fight now is to give her the most meaningful life I can.