The Hypochondriac's Guide to Life. and Death. (23 page)

To familiarize yourself with the basic processes of pregnancy, it is helpful to study diagrams of the male and female reproductive svstems.

Male Reproductive System

Female Reproductive System

Because women are often mistrustful of male doctors—fearful that men, whatever their book learning, cannot truly understand the process of childbirth—they often do not ask basic questions and remain frightfully ignorant of the totally natural process that is going on. Accordingly, I will now explain pregnancy, for our women readers alone, in a simple, sensitive, accessible, easy-to-understand format.

Basically, there are two stages of pregnancy:

Stage One.
You decide to wear that red dress with the back plunge, the one that shows off your behind, and that douche bag Warren keeps hitting on you even after your husband, who ordinarily does not have a jealous, possessive gland in his body, glowers him down a couple of times. Then, at home, you deny anything was going on, while doing that perky Elizabeth Montgomery thing with your nose, and just then,
like it's a total coincidence,
you decide to do leg lifts in your underpants, exposing those crotch-side hollows that don't even have a technical, medical name as far as I know, and then you get pregnant.

Stage Two.
You get real fat and your belly button pops out and you give birth to a baby.
1

The actual birthing process, from a physiological standpoint, consists primarily of grunting and screaming. Insensitive descriptions of the physical difficulty involved, usually by men, include such disagreeable analogies as pulling your lower lip over your nose or fitting a football through a keyhole. This is needlessly alarming. Giving birth is more like pooping a rocking chair.

Fortunately, the birthing process has been made far more civil since the days of the primacy of Natural Childbirth, wherein women were made to feel that if they did not give birth the way Iroquois squaws did in the 1400s, they were somehow less than real women. Nowadays, birth is far more genteel, through the advent of two medical advances: episiotomies and epidural injections.

Episiotomies.
At the actual moment of childbirth, to eliminate the possibility of tearing, your obstetrician tears you open with pinking shears. This causes no appreciable pain, in the sense that the chafing of your manacles causes no appreciable pain while the villain is slicing you in half at the sawmill.

Epidural Injections.
This is when you get a shot in your back that numbs the lower half of your body. This rather astonishing technomedical innovation lets the woman watch herself give birth almost as a spectator. She knows about the supposed pain of her contractions
2
but does not feel it. This is a great system of giving birth for those women who, through no fault of their own, are candy-asses.

Basically, there are two types of babies:

1. Babies with normal heads. These are delivered by cesarean section.
   

2. Babies with heads like cucumbers. (Here is an actual picture of my daughter, Molly, moments after her birth.)
   

Molly is now seventeen. She is a beautiful, brilliant young woman who, as I am writing this, has just walked in the door after a visit to the hairdresser. She appears to have gotten her hair dyed the color of a regulation NBA basketball. I do not know if this is related to her cucumber-head birth; as a scientist, I am just reporting what I see.

For most women, knowledge of one's pregnancy begins with the time-honored ritual of urinating onto one's fingers. Eventually, one hits the strip and it shows a little plus sign. In the ads for home pregnancy tests on TV, this news is usually greeted with a
blissful smile and a phone call to one's mother. Beside the phone is a vase of fresh lilacs. Someday I would like to see one of these ads in which the woman looks at the strip, gets up from a mattress on the floor of the basement storeroom she shares with a no-good, tattooed, unemployed shitheel snoring off his crack high beside her, walks to the kitchen, and sticks her head in the oven.

Whether the news is perceived as good or bad, a positive pregnancy test is a sign of health and fertility, unless of course it is a sign you are going to die. This is a fact not usually trumpeted by the makers of pregnancy testing kits. These tests detect the presence of human chorionic gonadotropin, or HCG, which is a hormone that is produced by the placenta. Unfortunately, there is a rare ovarian tumor, called an embryonal carcinoma, that also produces this hormone. So you might not be pregnant at all! You might have a malignancy that can grow to the size of a roll of toilet paper. It is often fatal.

Ordinary, levelheaded women often exhibit subtle signs of hypochondria when they are pregnant, calling their obstetricians at all hours to report mundane bodily events. Such behavior is completely normal, particularly for a first pregnancy. This is because the woman senses that for the first time in her life she is responsible for a life other than her own. The sensitive obstetrician will try to deal with these complaints with patience, gently but firmly reassuring the caller that everything is fine.

Caller: Doctor, I seem to be belching an awful lot.

Doctor: That's perfectly natural. Caller:

Caller: Also, I have a sore that won't heal, blood in my stool, sudden weight loss, a mole whose appearance has changed significantly in the last week, and a painless lump under my armpit.

Doctor: That's perfectly natural.

A pregnant woman frequently notices changes in her body that she might find alarming or distressing. These are, however, natural processes, designed to anticipate the wondrous events in her future. The woman and her doctor should work to emphasize their positive aspects. Her breasts will swell and may become
sensitive in preparation for lactation, for example; this can be sexually attractive to her husband or partner Because her appetite increases, and because the fibrous tissues that hold her joints together become slightly more elastic to prepare for childbirth, the pregnant woman's hips might spread so she has the overall muscle tone of a Hacky Sack. Her gross morphology may resemble those plastic punching-bag pop-up clowns with a wad of sand at the bottom, There are men who find this attractive as well; many of them advertise in the back of swingers'magazines, sometimes including Polaroid self-portraits taken in the restroom stalls at bus depots.

Medical books take great pains to emphasize that pregnancy is a totally normal, healthy state. Then they devote entire chapters to explaining how it can complicate virtually every disease the human body is subject to. Pregnancy increases the demands on the pancreas, so a diabetic is vulnerable to dangerous fluctuations in glucose levels. When pregnant, women with kidney diseases like glomerulonephritis can experience kidney failure. Women with sickle cell anemia can get serious infections or congestive heart failure. Women with heart disease have been known to bring a baby to term, give birth, and then die. Pregnancy can dramatically intensify the symptoms of lupus erythematosus, rheumatoid arthritis, and multiple sclerosis. Pregnancy typically elevates blood pressure, so a woman with hypertension will sometimes have a stroke. A fetus can also dangerously complicate diagnosis: Because the fetus pushes the appendix up, when pregnant women get appendicitis, the pain is not where it customarily is. It seems to be gas or normal abdominal cramping; this can lead to a delay in treatment, and sometimes a life-threatening crisis of peritonitis.

Here is a listing of symptoms sometimes exhibited by the pregnant woman. In column 2 are the most likely explanations. In column 3 are the most terrifying explanations. Hypochondriacs are urged to ignore column 3.

And finally, some commonly asked questions about pregnancy.

Do you think some women milk their pregnancies just a little too much, making their husbands run out in the rain at nine o'clock at night to pick up some nauseating combination of food, like blueberry yogurt and sardines, and then bursting into tears when you suggest, real politely, an alternative snack, God forbid she should have to eat tuna fish?

No.

HOW did you, personally, discover what female genitalia look like?

I was approximately eleven years old and went to the bathroom in a doctor's office. On the wall, discreetly placed, was a card with an illustrated diagram showing men and women how to use a sterile tow-elette
before giving a urine sample. The illustration was extremely clinical, but also extremely detailed. I stole the card.

Is that the only thing you ever stole? In your life?

I believe so.

What is the funniest headline ever published?

That would be the headline printed in the
Bucks County
(Pa.)
Courier-Times
in 1977, above a medical story: C
ERVICAL
C
ANCER
C
AN
B
E
L
ICKED.