Media Coverage

Decisions About Medical Care Are Often The Hardest Decisions, But They're Women's To Make

Nurses never forget the tragedies in the lives of the people in their care.

● The young soldier with parts of his body blown off in a horrific explosion.

● The young child with cancer slipping slowly away along with the hopes and dreams of her parents.

● The young mother in the emergency room, bleeding, frantic about the fate of her unborn child.

I started my nursing career more than 30 years ago, working first with the sick and wounded in a Veterans Affairs hospital, later as a labor and delivery nurse in the maternity ward and Neonatal Intensive Care Unit (NICU) of a Catholic hospital.

I shared the joy of many mothers whose pregnancies ended in the birth of a healthy child. But I also shared the agony of other mothers whose pregnancies ended for many different, complicated and often inexplicable reasons. A life just beginning was lost, and the life of the survivor forever altered.

What I would like to share in this message is that decisions about medical care are often the hardest decisions we make in our lifetimes.

Those decisions should be ours to make, with advice from our loved ones and from caring, competent medical professionals.

Those decisions should not be made — or complicated or restricted — by state legislators.

Here are some real-world examples of how difficult and complicated women's health issues can be:

● A pregnant woman was brought to the emergency room after being found nonresponsive by her husband. She was at death's door with a fever of 107 and was diagnosed with amnionitis (infection in the fluid around the baby). We administered the required extensive interventions, intubation, IV fluids, antibiotics, cooling blankets and more, but she was not expected to live. Her fetus had an irregular heartbeat and showed no movement. The only slim chance of saving the mother's life was to terminate the pregnancy and remove the infection. Our ethics committee held a quick meeting and obtained, as required, input from the hospital's assigned Catholic priest. The priest agreed immediately that the pregnancy should be terminated, noting that living mothers can have more babies and that the three children under 6 she had at home needed her care. The mother remained in intensive care unit for several weeks, but recovered and several years later had another child.

● With advances in technology, many birth defects can be anticipated. But one of our patients lived in a remote area where ultrasound testing was unavailable, and she was near her delivery date when we learned that the child had a devastating defect — he had no abdominal wall, and his internal organs were outside the body. While there was no way for the baby to survive, the mother did not want to terminate the pregnancy. She wanted to have the baby and hold it. Sadly, when the baby arrived, neither of the parents could bear to look at the child. I wrapped the child in a blanket and held him until he passed a couple of hours later.

● While I was working at a university hospital in the South, an older adult man brought in a young girl in pain for treatment. He did not want doctors or nurses to talk to the girl and had to be threatened with incarceration before he would leave the room for an examination. The girl was estimated to be 10 to 11 years old and 16 weeks pregnant. She was scared and cried incessantly. She was afraid of the man and stated that he hurt her "down there." She cried out for her mom, but could not tell us how to notify her. When told she was pregnant the girl started to scream and push on her belly. She did not want to be pregnant. Police were notified, and the man turned out to be her uncle, who was arrested. Her parents were found, and even though the girl would not say anything about the uncle, it was a clear case of incest. A physician offered to terminate the pregnancy, and the family agreed.

The common denominator in all these cases is that women and their physicians were free to make difficult and heart-wrenching decisions without fear of prosecution for breaking a law.

What law or set of laws could ever be adequate to anticipate every circumstance, every complication involving a woman's health? What state bureaucrat or lawmaker is a better judge of what decision is best to make in distressing and often urgent health-related situations than the woman herself and her medical team?

Women alone have the privilege and the burden and the responsibility of bearing children. None in my experience have taken pregnancy lightly.

Physicians and nurses take seriously the oath they take to "do no harm." Their expertise and their devotion to their profession and their patients should be respected — not restricted, dismissed or put under risk for prosecution for political reasons.

A new organization in Oklahoma called "We Are Rising" is undertaking the challenge of bringing to public attention the importance of allowing women to make their own choices about health care. Men often seem to take this right for granted when they argue that "no law should make me wear a mask or have a vaccination!" I encourage you to learn more about this group at www.Wearerisingok.Org and join this important cause.

Marva Cummings-Wertz

Marva Cummings-Wertz is a registered nurse, former chief nursing officer at an Oregan hospital and a former executive at two major health care companies. She lives in Oklahoma City.

This article originally appeared on Oklahoman: Women, medical team better to make health decisions, not lawmakers

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'I Went Into Medicine To Help My Community'

Nov. 19—LAPWAI — When Dr. Kim Hartwig first decided she wanted to become a doctor, she was 13 years old. Hartwig's older sister, a national-level basketball player on an Amature Athletic Union team, had torn her ACL and Hartwig remembered being marveled by her sister's recovery.

"She played like she wasn't ever injured, and I was just amazed at that recovery, and attributed her success, her full return to the court, to the doctor," Hartwig said. "So, I was going to be a doctor who fixes little girls' knees so they can play basketball."

Hartwig, a 1991 Lapwai High graduate, didn't know any Native American doctors growing up. However, her connections to her family and community would continue to be a driving force in her career.

Now the director of Nimiipuu Health in Lapwai, Hartwig is setting an example she didn't have growing up. In some ways, not knowing just how hard the process would be helped her to get through it, she said.

"It's like when you first run a route that you don't know. It's not as challenging the first time because of the unknown but when you go the second time, you know how much longer you have and you know where the hill starts. So, I think that naivety really helped me to not — not fail myself."

For many Native students and kids from small towns, Hartwig said, leaving behind a powerful support system is a big challenge when they go to college.

Hartwig attributes a large part of her success to the people she connected to away from home — her college basketball team and other Native people she met.

"My junior year at Loyola Marymount, I attended an elders gathering with our Indian club, and I realized when I arrived I hadn't seen anybody that I knew. But I felt this immediate sense of warmth and knew that I needed to have my Native community around me."

Hartwig applied to three medical schools, all of which had Native American centers of excellence. She ended up at the University of Washington, where she participated in the Washington, Wyoming, Alaska, Montana and Idaho (WWAMI) medical program.

WWAMI connects medical students to rural communities in the five states, including places like Hartwig's hometown. Returning home was always the plan, she said.

"As a physician, I could be anywhere. It's a very versatile field. But I went into medicine to help my community."

While in her first year of medical school, Hartwig got pregnant. In some ways, she said, it was easier to have a baby in school rather than after. In her residency, there were 20 people to help pick up extra work instead of the six doctors at her first practice.

Still, it was a challenge. When Hartwig returned to school, she said, many of her professors were surprised to see her.

"I was a Native student in medicine, which they didn't have very many of, and I had a baby. When they gave me my exam, they were like, 'Oh, we didn't think you were gonna show up,'" she said. "I was like, 'Well, I'm here, though you don't know who I am. Can I have my test?' And my daughter was sitting with me through all of my finals that year."

After having her first daughter, Hartwig took a year off from school. When she returned, she went into a meeting with administrators to talk about her plans. She only later learned why they had called that meeting.

"They were deciding whether I can continue school or not," Hartwig said. "And I had no idea."

Hartwig continued on and had two more children while in school. When she started practicing, she said, the experience helped her be a better doctor. She was equipped to understand the realities of family life that her patients dealt with.

"Like, seeing a kid with bruises on the front of their shins, not immediately jumping to some sort of abuse, but 'that's an active kid that likes to climb,'" she said. "Understanding the social dynamics that impact health care that a lot of times you don't understand without having the responsibility of a family."

Balancing physical, spiritual and emotional health is an important part of Hartwig's approach to wellness. She just turned 50 last year, and still plays in a summer basketball league.

"That's really where I feel like life flourishes," she said. "That's really what we're trying to do in medicine."

Hartwig brings the same holistic approach to her work at Nimiipuu Health. It translates to a wide array of wellness programs and an investment in building trusting relationships with patients.

Keeping doctors in rural and reservation towns can be a challenge, Hartwig said. Many who seek jobs at reservations are there because they can get student loan repayment through Indian Health Services.

That can make Native health centers a "revolving door" for early-career doctors. So, one of the first questions new providers are asked, she said, is how long they plan to stay.

"Those two initials after your name don't mean a lot in our community. You're here to provide care," she said. "The privilege that it is, for us to provide care — we need to remember."

Hartwig said for doctors who stay there is a big reward. When providers take the time to earn their patients' trust, word gets around.

"When you have a good experience in the clinic, the auntie will go home and tell her sisters or her brothers, and then people will start coming asking for that provider," she said.

Part of rural and Native health care is fostering the next generation of providers. Some programs, including WWAMI, help bring more students, and eventually doctors, into rural communities.

Native doctors like Hartwig are still few and far between. One other Nez Perce doctor, Hailey Wilson, currently works in a tribal community in Arizona. There aren't many.

It is something that Hartwig thinks about, especially as she looks to the future, and who might eventually succeed her as director. Hartwig said she and her colleagues are trying to open the door for a future where the clinic might see more doctors from its very same town.

"We have some discussions going on now with Oregon Health Sciences (University) to develop a pathway," she said. "We just need to let our kids know, it's doable. I was naive in my ambitions but now they have a tangible model for them to know that it can be done."

That investment in the future is big for Hartwig. She takes time in her appointments with kids, letting them listen to their siblings' heart through a stethoscope or look at their throat.

"Those things are really important for kids to know that, that's not something that's off limits," she said.

Hartwig said being a healer goes beyond treating physical ailments.

"For Nimiipuu Health to be a true place of healing we can only heal ourselves first, and that's my ultimate goal is for our community members to be able to heal."

Hartwig's patients, and her own family, have much to heal from; be it forced assimilation and loss of language, which happened to Hartwig's own family, or a loss of bodily autonomy for Native women at the hands of IHS doctors.

When she returned home to Lapwai four years ago, Hartwig said, there was still a building standing in town where tribal members were forcibly sterilized.

"I didn't realize that, that was why all of these grandmas," she said speaking of local elders, "that's why they didn't have children."

Hartwig said her being here despite those hardships speaks to the strength and wisdom of her ancestors, who foresaw a need for housing, health care, education and hunting rights written into treaties.

Now, Hartwig is working to build a brighter future, strengthened by what she and others had to go through.

"All of their work and sacrifices, that's why we're here, and our job is to prepare for, even when we cross over, that people are still here with health, and have an identity in our culture."

Sun may be contacted at rsun@lmtribune.Com or on Twitter at @Rachel_M_Sun. This report is made in partnership with Northwest Public Broadcasting, the Lewiston Tribune and the Moscow-Pullman Daily News.

What Are The Early Signs Of Pregnancy?

Early signs of pregnancy are varied. They can include a missed period, nausea, frequent urination, and fatigue.

Early pregnancy and premenstrual symptoms are often similar, and it can be hard for a person to tell whether they might be pregnant or about to get their period. Also, some pregnant people do not experience the typical early signs.

The article explores 12 changes that can point to pregnancy in the early stages.

Missing one or more periods is often the clearest early sign of pregnancy. We explore these and other signs below.

1. A missed period

This is often the first sign that a person notices, but missing a period does not always point to pregnancy.

A person might miss a period for many reasons, such as changes to birth control medication or sudden weight loss. A missed period can also indicate a health issue, such as polycystic ovary syndrome.

For this reason, anyone who unexpectedly misses a period should contact a healthcare professional as soon as they can.

2. Nausea

Nausea during pregnancy, or morning sickness, is common. It can begin as early as 4 weeks into the pregnancy.

For some people, it eases early on, and others experience it throughout their pregnancy. Most pregnant people experiencing some degree of nausea.

3. Breast changes

These may occur within 2 weeks of conception.

The amount of breast tissue increases in preparation for milk production. The veins of the breasts become more noticeable, and the nipples may darken.

The breasts and nipples may feel tingly, sore, and extra sensitive.

4. Frequent urination

This often begins early in pregnancy, and it results from various changes, including:

the uterus expanding

hormonal changes

an increase in blood volume

an increase in blood circulation to the pelvis

an increase in kidney size

Later in the pregnancy, the pressure of the growing fetus and uterus on the bladder may result in even more frequent and urgent urination.

Learn more about pregnancy trimesters here.

Contact a healthcare professional if urination becomes painful, as this can stem from a urinary tract infection.

5. Fatigue

Fatigue is one of the most common early pregnancy symptoms. It may be most intense in the first 12 weeks.

During pregnancy, the body produces more of the hormone progesterone. This is essential for a healthy pregnancy, but it may also contribute to fatigue.

In addition, the body needs to pump more blood to the fetus as it grows. This, coupled with the increased physical demands in the later stages of pregnancy can lead to more fatigue.

6. Cramping

Mild cramping without bleeding is common in the first trimester, and it may feel like menstrual cramps. It results from the uterus expanding.

Abdominal bloating, constipation, and heartburn also tend to develop early in a pregnancy, and they may last throughout.

7. Nasal congestion

Hormonal changes during pregnancy can cause a stuffy nose. While this can occur early in pregnancy, it is more common in the third trimester.

8. Food cravings and aversions

These are common throughout pregnancy, and they may result from hormonal and physical changes, rather than shifting nutritional requirements.

The underlying cause of food cravings and aversions is still unclear. Different people seek out and avoid different foods.

Regardless, it is important to take in the right amounts of nutrients and calories.

Learn more about the diet during pregnancy here.

9. Mood changes

Sudden shifts in mood can stem from hormonal changes, fatigue, and stress in early pregnancy. It is normal to feel increased emotional sensitivity and abrupt fluctuations in mood during pregnancy.

Pregnancy can also cause relapses of existing mental health conditions, such as depression and anxiety.

10. Lightheadedness

This can result from a range of factors, including:

changes in hormones

changes in blood pressure and volume

altered balance due to weight changes

iron deficiency anemia and other health issues

A person may be more lightheaded when they change positions, such as standing up, quickly.

While some lightheadedness may be expected, a person should contact a healthcare professional if it persists after they sit or lie back down.

11. Headaches

These are common in early pregnancy and can result from changes in hormones.

Typically, headaches cause no harm to the fetus. However, headaches can be a symptom of preeclampsia, which can lead to serious complications without treatment.

Anyone who experiences strong headaches, especially with changes in vision, should contact their doctor.

Learn more about preeclampsia here.

12. Bleeding

Bleeding may be common during early pregnancy. While it may be harmless, a doctor should investigate the cause.

Implantation bleeding occurs when the embryo attaches to the wall of the uterus. This can cause light bleeding or spotting. It may happen around the time when the person would have expected a period.

Early pregnancy symptoms are general — they can also stem from health problems. For this reason, it is important for a healthcare professional to confirm the cause as soon as possible.

Blood and urine tests

Pregnancy tests check for the presence of the hormone human chorionic gonadotropin (hCG). A person might take an over-the-counter test at home, or they might visit a clinic and provide a urine or blood sample for testing.

The body produces hCG after implantation. Some rare conditions and diseases can also raise levels of this hormone.

It is a good idea for anyone who has received a positive test result to have this confirmed by a healthcare professional.

Various pregnancy tests are available for purchase online.

Ultrasound

An ultrasound scan produces an image of the fetus using sound waves.

Doctors typically use these scans to check the progress of a known pregnancy, but they can also confirm whether a person is pregnant and help detect multiple pregnancies.

If a person has any pregnancy symptoms, they should contact a healthcare professional. Once the pregnancy is confirmed, having consistent prenatal care improves outcomes for the pregnant person and the fetus.

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