One thing that nurses do is interview patients. Every now and then, you’ll see a narrative written by the admitting nurse which includes the phrase “Patient is a poor historian.”
This can mean lots of things, but the basic takeaway is that the patient does not know what the shit they are talking about. They either can’t put together a coherent narrative because they are too incapacitated to do so (I would have been like that in those early days after Nathan died, for example), or they’re simply unable to string together events in a chronological fashion with any accuracy (think about the person who tries to give you directions and you know it’s not gonna work).
Joe and Nicole Naugler are poor historians. I used to give them the benefit of the doubt, but then one day I was involved with Joe Naugler personally.
I found out rapidly that Joe has no grasp at all of the truth of what actually happened, even when he was present and even when he recorded audio of part of it, and Nicole doesn’t mind just making up stuff even when she wasn’t present at all.
And I really do not think they always know they are doing this. Obviously, when Nicole says that Nathan’s accidental death was really a suicide because I was a dreadful mother and Dave just watched me abuse him and didn’t stop me because he’s a wimp, she’s just plain lying, but sometimes I think Joe and Nicole hear what they want to hear, not what was actually said.
The only account we have, and the only one we’re likely to ever have, of the tragedy that occurred last week is from Nicole.
That means, because she is a very poor historian, that we have to take it all with a grain of salt. Please keep that in mind. In addition, we have no other historian, so the only thing I can do is take what poor information Nicole shares and then explore the possibilities.
First, let’s deal with the facts, and there are some that we can be reasonably certain about. We can begin with a piece I wrote in May. It’s a little bit eerie to read it now with hindsight.
Nicole is 41 years old. In obstetric-speak, she’s a very old woman. That in itself makes her high risk.
According to her, she has been pregnant 15 times, with 12 of those pregnancies (at least) going to full term. That makes her a great grand multipara. “Para” means birth, “multi” is obvious, and “grand” means more than 5 pregnancies, “great” is added for more than ten. It doesn’t get grander or greater than that.
What you get in terms of reproductive equipment is genetically determined. You can’t control it. Your mother can’t control it (unless she does genetic studies on reproduction and mates with a male who carries good genes).
I began my reproductive years with a very small compact car that just didn’t have enough room in it for shit, something like this.
Nicole Naugler began her reproductive years with a Porsche.
Here’s what she has now.
This is not her fault. It’s a result of combining age and use. It has nothing to do with grooming dogs, or living in a garden shed, or eating what some folks pick about and call a poor diet. It’s simply a fact of life.
We age. Our organs wear out.
And the risk of having the whole pregnancy thing get a glitch goes up the older you are and the more pregnancies you’ve experienced. Shit just gets worn out and there is no way to replace the brake system even if you do it carefully and don’t sit right under the damn thing while you’re working.
So we’re talking risk here. How much risk?
A pretty good bit. Grand multips have a three times greater risk of placenta previa, for example (placenta low in the uterus, and it gets caught between the fetus and the cervix during delivery ). The one thing I found that gives grand multips an advantage is that they tend to be able to deliver breech babies better.
By the way, one criticism that the homebirthing crunchy crowd makes about studies involving multiparas is that they’re typically done in third world countries. They argue that those women aren’t comparable to American women, so ignore the results.
I’d call this third world.
The bottom line here is that these two factors, advanced age and multiparity, taken alone, increase Nicole’s risk of trouble in pregnancy.
But wait, there’s more.
In addition, she refuses to get prenatal care of any sort. It’s anybody’s guess as why she does this. Her own explanation is that she eschews all medical attention, period, because it’s all stupid and a waste of money and time and she can study stuff on Youtube and know everything anyway.
I think it has more to do with money. Prenatal care costs money. Doctors don’t do it for free. Nicole hasn’t seen any benefit from spending that money, and so she doesn’t do it.
I remember prenatal visits. They seem like a colossal waste of time. You strip, sit on a examining table until your feet swell and you have to go pee yet again, and then the doctor comes in and takes ten seconds and you’re out the door. It feels a little like being one of our calves when we’re lining them up for deworming.
I sort of understand why women begin to get the idea that they don’t need all that. They have shit to do and sitting in the doctor’s office spending money on nothing isn’t on the list.
But not doing it is risky. Don’t get prenatal care and your baby has a 40% greater chance of dying.
Add in going overdue, as Nicole did, and that risk doubles.
Why is that? Why does going to the doc’s office and sitting on that examining table make your baby safer? Hell, they measure you and every time it’s normal. They weigh you and yes, you’ve gained a little weight. You’re pregnant, so of course you’ve gained a little weight.
But they do other stuff. They take those measurements and they compare them with last month’s measurements and they draw some blood and they compare the results of that with what it was the last time it was done and they see danger signals before it becomes a five-alarm fire.
What you’re paying for is a little insurance to reduce that risk. And whether Nicole thinks it’s important or not doesn’t matter. The risk is there even if she ignores it. Science and biology do not care if you don’t understand them.
Personally, I’d say that with 15 pregnancies, Nicole didn’t give it all enough thought.
So here’s what happened, according to our poor historian.
She was great. She felt fine. She was perfectly healthy. Except when she wasn’t. She did multiple video rants during this pregnancy and she never really looked good. Some of that could be attributed to poor lighting but not all of it. She seemed to have a constant cold or sniffles. And I seem to remember her complaining about headaches, but maybe I’m wrong about that.
The bottom line is that we don’t know what her condition was prior to July 21 and neither does she. She has no idea what her blood pressure was. You cannot feel high blood pressure. She does not know how much amniotic fluid was present or when it started to go away. She doesn’t know what her blood work looked like.
Anyway, she was fine, and she got up on Friday morning and found time to argue about prenatal care.
They go to the hospital when things are more than they can handle.
Well, things became more than they could handle right after she wrote that.
On her way to work, she says, she had some pain which she thought was “gas or contractions.” She felt dizzy, nauseated and began passing out. She basically collapsed at the grooming facility.
Joe plopped her in the van, raced to the hospital, and she was admitted immediately. They did blood work which was so bad that they repeated it because they thought it was a mistake with the machine.
I can guess that the blood work involved clotting stuff and that’s where they figured out that she had DIC or disseminated intravascular coagulation. Those are big words that just mean that her clotting mechanism was all fucked up. The blood clots but all wrong. It’s a life-threatening medical emergency.
DIC is not a primary condition. It always has a cause. To cure it, you find and cure the cause. In her case, the cause was pregnancy related.
She also tells us that she had no amniotic fluid. Amniotic fluid doesn’t just go away. If there isn’t any, and the membrane hasn’t ruptured (it hadn’t), then it went someplace. It was reabsorbed and no new amniotic fluid was made, which means that the placenta in that old VW microbus was basically out of gas. Or perhaps it had an alternator that quit. Something was wrong, and it didn’t go wrong on the morning of July 21. It had been wrong for days. There is no suction mechanism in the uterus that sucks up amniotic fluid like a wet-dry vacuum cleaner.
Here’s the poor historian stuff. She tells us that she had pain on the way to work. She then turns around and says that she did not have any pain or “distress.” I would say that throwing up and passing out constitutes distress, but that’s just me.
At this point, the doctors were between a rock and hard place. To cure DIC, they had to get rid of the cause. The cause was the contents of Nicole’s uterus. Come hell or high water, they had to get everything out.
Surgery is often the answer in a situation like this because it’s fast. That’s the big plus.
The big minus is that it creates even more trauma (and trauma is one of the causes of DIC) and it also creates yet another place to bleed from.
Since she started into labor on her own, they decided to let her labor, but she says that they took her to ICU to do that. I assure you they didn’t do that because they just love to have laboring women in ICU. They did it because she was really in big trouble. They were monitoring her progress by the second and they were ready to get her into an operating room pronto if they had had to.
Because her uterus was in fucked-up mode, her labor was also in fucked-up mode, and ultimately she needed a bit of pitocin (it’s a hormone which is made naturally by the body to make the uterus contract) to move things along. I am actually sort of surprised that they let her labor for five hours. To do that, her labs had to be staying fairly stable after they loaded her up with some plasma and other stuff.
At any rate, she delivered the baby, who had been dead for quite some time. Not a super long time, but probably overnight.
Their guess at what happened was that the placenta had started to calcify, the baby out grew what the placenta could manage and the amniotic fluid was too low.
Okay, remember we’re dealing with a poor historian here, but this is what she tells us, so I am gonna go with it.
None of this stuff happens overnight, folks. It simply does not. This is not a 12-hour deal. The baby outgrew. . . The baby was overdue. The VW microbus couldn’t keep up and failed. But the dials indicated trouble before the sputtering began.
The problem was that there was no one to read the dials.
Not only was there no one to read the dials, Nicole made it clear on the previous Monday that she specifically would not go to the doctor for the very reason that she didn’t want them to read the dials, for fear that they would start labor.
She was monitoring her own health.
Only she wasn’t. She couldn’t. How could she monitor the amniotic fluid level? How could she monitor the function and viability of the placenta? How could she know that her platelet count was falling like a rock? None of those things cause anything you can feel until you’re in really big trouble.
They said even if they had detected it, we probably couldn’t have saved William.
Remember what I said earlier. Joe and Nicole both have a tendency to hear what they want to hear, not what is said.
The medical personnel involved in this were dealing with a gravely ill woman who had just delivered a dead baby. The last thing on earth they are gonna say to her is, “Oh, yeah, this was entirely preventable. If you’d just had prenatal care like you should have, you’d have a living child right now. We’d have probably induced labor last week sometime.”
For one thing, no doctor is going to give you a blanket, “yes, I could have saved the child” statement. They just aren’t. They don’t know if they could have or not because they can’t see what a prenatal visit or visits would have shown.
Since they cannot possibly know what Nicole’s condition was on July 4, they cannot say what they could have done or might have done or would have done on July 4, or on July 14.
What is absolutely true is that Nicole didn’t know what Nicole’s condition was either. She couldn’t have. She doesn’t have the equipment or the expertise to know.
So to summarize everything, Nicole’s pregnancy was high-risk. It would be hard to get more high-risk than she was unless you had some serious chronic underlying illness. Every pregnancy she had put her at higher and higher risk.
Yet she continued to ignore those risk factors and insist that she would somehow know that something wrong if anything were to go wrong and that her “body” would tell her.
This is sort of like pointing a gun at her baby’s head with each pregnancy. During the first few, there were a lot of empty chambers and only one bullet. The odds were in her favor. She would pull the trigger and hear a “click.”
But instead of understanding that she’d played Russian roulette and beat the odds, she believed that her luck was due to her knowledge, or her experience, or her innate ability, or a combination of all three.
Over time, she was dealing with a gun, still pointed at the baby’s head, only now there were two bullets and few empty chambers. She still heard “click.” She had no idea how many bullets were mounting up in those chambers.
But as I said before, it doesn’t matter if she didn’t know. It doesn’t matter where she placed her trust. Science and biology give not one shit. They just went on adding bullets to the chambers.
And this time, when she pulled the trigger, there was a live round in the chamber.
And a little addendum:
In that case, Nicole, suck up your moral principles, toss your pride aside, apply for Medicaid and don’t stiff them. They saved your fucking life, even if your poor choices made it impossible for them to have the slightest chance of saving your baby, and they also have house payments to make, and brakes on their cars that need fixing, and groceries to buy.
They owed you absolutely nothing. You owe them big time. Pay them.
You know perfectly well you do not have the money to do it. You understand by now that people are not going to donate enough money to pay this.
Go get Medicaid.