Given the Gawker mandate to be glib and ruthless, whether or not they know what they’re talking about, I won’t pretend to be shocked by a dashed-off remark in Monday’s post on Kate Middleton’s pregnancy:
The Palace also reported that Kate was admitted to the hospital today with “hyperemesis gravidarum,” which is what they call regular old morning sickness when you are a princess.
Nor, for more or less the same reasons, was it surprising to watch the ladies of “The View” dismiss the duchess’s condition with a flurry of bubbly interruptions, ignoring a nurse’s earnest response to Barbara Walters’ half-hearted question about whether HG is serious: “It can be,” the nurse said sheepishly. (In an open letter to the duchess, HG sufferer Betsy Shaw gives Kate “permission to slap” Walters.)
I have no idea whether Kate has HG or not. But the fact remains that it can be a brutal, crippling condition that goes largely ignored and untreated, partly due to its overlap with ordinary pregnancy sickness and partly to our attitude toward suffering and the suffering of pregnant women in particular. As Atul Gawande noted in an indispensable 1999 New Yorker piece on nausea and vomiting, “A surprising number of doctors still believe in the discredited Freudian theory that hyperemesis is due to an unconscious rejection of pregnancy.” Little seems to have changed since the last century — or the one before, for that matter.
Anybody who’s had HG knows how preposterous the psychosomatic theory is. Apart from being frequently compared to weeks or months of daily chemotherapy (some of the most common medications for it are, in fact, off-label chemo pills), HG can lead to malnutrition, dehydration, depression, and worse. It’s so unbearable in some cases that women have been known to opt for an abortion.
Some believe that Charlotte Brontë, who wrote Jane Eyre under the (m)alias of “Currer Bell,” died from complications related to HG, and not from from tuberculosis as was thought at the time. There’s also speculation that it may have been typhus, but if you know anything about the symptoms of either then you know everything you need to about the suffering HG has the potential to cause.
Even now, excited and just two weeks to go before her due date, my wife Jac likes to sleep a lot. A lot. Like a marathon runner who’s lost a leg and can only compete in her dreams, Jac is free from the crippling nausea and vomiting only when she sleeps. When I bring the PB&J on toast, glass of water, and two pills each morning she raises a flimsy thumbs-up without rolling over.
Some days are good. She can have a conversation, manage a strained laugh, maybe even take a walk. She’s still nauseated at every moment, but maybe she makes it through the day without vomiting. Which does happen. Other days, and these tend to be strung together, she can barely sit up, and just the effort of having a conversation makes her shudder and rush to the bathroom, retching all the way.
Even the quality of the vomiting is different. Violent and persistent, it can often resemble drowning, particularly when it becomes so painful and scary that it’s interrupted by moans and cries. Last month, I forgot to eat breakfast before taking some vitamins and found myself over the toilet. After a few terrible minutes of nausea the pills came up and I felt better almost immediately. A few minutes of nausea. One of the cruelest parts of HG is that vomiting provides zero relief; you feel just as bad as the moment before.
But the cruelest part may be that the suffering isn’t just physical. Well before Gawker and “The View” pooh-poohed HG as morning sickness for the privileged and prissy, Jac and I had become accustomed to otherwise compassionate people responding more or less the same way.
For eight months I’ve watched Jac face condescending doubters, well-meaning assurances that it’ll go away in the 10th, 12th, 15th, 18th, 20th week, etc, the “yeah, honey, we all went through it” cruelty sorority, and the reluctance of doctors to dispense medication that has no demonstrated side effects because of orthodoxies about pills and pregnancy.
Like any close-knit community born of suffering, the chat boards where Jac has found the majority of her comradery, compassion, and information has its private jokes and neologisms that have little meaning to those on the outside. They’re for sufferers only. But for this tourist, the most comprehensible and heartbreaking of the lot has to be what they call “crackering.”
Most women who find their way to an HG message board have also done time on Google in a desperate attempt to make the suffering go away. By the time they reach a medical professional they can likely recite the “Have you tried?” litany at least as well as the pros: Have you tried ginger? Have you tried Sea-Bands? Have you tried sucking candy, bland foods, chewing gum, citrus, eating frequently, eating protein, eating carbs, not eating carbs, not drinking when you eat, not sitting after you eat (but not making sudden movements), not eating too fast, not sniffing, brushing your teeth after every meal … and of course: Have you tried eating some crackers?
Picture your head caught in a vice — an invisible one. The pain is excruciating, you’re dizzy, and it’s so heavy your neck and all the muscles up and down your back, hips and legs are throbbing. You can’t get comfortable and you can’t eat. You try everything to relieve the suffering. Your head is caught in a vice, for chrissakes.
But when you finally visit the doctor seeking validation and relief after having been dismissed by those around you (including other headache sufferers), having done extensive research and found that any number of folk remedies just haven’t cut it, the doctor looks at your pitiful mug, perhaps thinking of the headache he or she once had, and says “Have you tried aspirin?”
That is more or less how we might understand what it is to be “crackered.” When an HG sufferer seeks understanding, compassion and hope only to be asked whether they’ve tried crackers (or ginger or Sea-Bands …), it’s as though they’ve been offered aspirin for a major head injury, with no acknowledgement of the awkward tool attached to their head.
Partly due to this invisibility and partly to the suffering itself, depression is common among HG sufferers. At 24weeks (18 with HG), when it became clear that Jac’s condition would last the duration of the pregnancy, our midwife urged us to see a reproductive psychiatrist in order to help us cope. Knowing how susceptible Jac was to feeling invalidated I spoke to the prominent (and pricey) specialist in advance to humbly offer some background information.
When I picked Jac up two hours later she was crying. She’d been crackered. Not only had the doctor asked whether she’d ever tried ginger and crackers, but she seemed far less interested in her acute and temporary suffering and far more interested in connecting these validation issues with her early childhood.
Either the doctor believed that 16 weeks was sufficient time to make progress on early childhood dynamics to help her suffering or that the issue of validation was family specific and not one that, regarding HG at least, was largely cultural. Giving her the benefit of the doubt that no therapist worth their name plaque believes that progress like that can be made in 16 weeks the only option that remains is what the HG boards might call “psychiatric crackering.”
In addition to avoiding the burden that the failure to legitimize actual suffering can cause, it turns out there’s another reason to listen to pregnant women more carefully: early treatment is the best hope. According to Gawande, since vomiting and nausea are exceedingly difficult to treat once they begin, it’s best to start treatment as soon as symptoms develop. In fact, he points out that:
Back when doctors didn’t hesitate to prescribe antiemetics for ordinary pregnancy sickness — at least a third of pregnant women were on such drugs in the 1960s and ’70 — hyperemesis was much less common.
And “treatment” need not be strictly medical. Physician Eric J. Cassell’s research on suffering has shown that something as simple as understanding can help control suffering when nothing else will work … not even crackers.
During the early weeks of her pregnancy we went through with a poorly timed trip to Paris, during which Jac spent three miserable weeks in bed, unable to keep food down and dreaming of the day she could “drink a whole bottle of Poland Spring water without throwing up.” (Another side effect of suffering: the shrinkage of goals.) I wandered the streets dreading the onset of hunger, when I’d have to endure the humiliating experience of being that American tourist who speaks no French, and visiting cathedrals, where words weren’t required.
In one of the smaller, poorly kept churches a mural depicting fruit thieves Adam and Eve reminded me of one of G-d’s sentences: “To the woman he said, I will greatly increase your pangs in childbearing; in pain you shall bring forth children.” Is it possible we still harbor, deep down and in wholly secular terms, the idea that the suffering associated with bearing a child is punishment for Original Sin?
As we enter the last couple of weeks of pregnancy, Jac can drink a whole bottle of water and there are signs that her patter is returning. She asks why her friends and I can’t squeeze him out like a toothpaste tube, and why he won’t just “pull the lever” already. She dreams of a solo trip to Mexico for the day after he’s born. “Nine months in my body. Your turn now.” Only there isn’t much joke to the joke.
Those who do appreciate what she’s endured often suggest that we hold it over his head. “Know how hard your mama suffered? Better listen to her,” they joke.Typically appreciative of a good-natured smackdown Jac doesn’t seem interested this time. I don’t think she wants him burdened with guilt or original sin, whatever the form.
Evan Derkacz is co-editor of Religion Dispatches.