hormonal contraceptive

Why Am I Here? Thoughts on Survivor’s Guilt

2230 views

“I’m so glad to see you. I didn’t think you were going to make it.”

If you’ve read my story, you may remember that is what the emergency room doctor said to me a few weeks after I had a stroke. I had only been out of the hospital for a week when I developed a rash from the seizure medication I was taking. Because it was a Friday night, my neurologist told me I needed to go to the emergency room. I cried as my in-laws drove into the parking lot of the little local hospital. It was the very same hospital that had sent me home twice before finally discovering, days later, that I had blood clots and was bleeding into my brain.

“You’re a miracle.”

One of the advantages of having a stroke at 28 is that when you return to the ER, they finally take you seriously. I was ushered into an examination room within 5 minutes of checking in. As I waited to be seen by the doctor, a nurse came in. She was very excited and a little emotional.

“Hi,” she said. “Don’t you remember me?” I did not. “I sat with you for hours when you were in here a few weeks ago.”

I immediately began to feel very guilty for not remembering this lovely woman who so obviously cared about me. She took my hand in hers. “You’re a miracle,” she said reverently.

Confused about what the appropriate response to that was, I smiled meekly and said, “Thank you?” When she left the room, I could hear her talking to people up and down the hall. “The miracle girl is here!” she said over and over.

Later, I would lay in bed, or sit on the couch, or ride in the car and wonder, “If I’m such a miracle, why am I here?” What was an enthusiastic and loving sentiment from that nurse turned into a real mindf*@k (pardon the language but there was really no phrase that worked as appropriately here) as my poor, broken brain puzzled over why I had survived.

What is Survivor’s Guilt?

Trying to understand your purpose in this world is a tough enough task. Nevermind trying do it while you’re struggling to just tie your shoes and feed yourself. I wanted to put it out of my mind and just take things one day at a time. But it was hard to do that. There is so much uncertainty during and after a health crisis like a stroke. What will my life look like now? Will it ever look like my life before? Do I want it to look like my old life? Of what kind of life am I even capable?

At the time, I wouldn’t have called it survivor’s guilt, but that may have been what I was dealing with. Survivor guilt (or survivor’s guilt; also called survivor syndrome or survivor’s syndrome) is a mental condition that occurs when a person perceives themselves to have done wrong by surviving a traumatic event when others did not.

Though more common, or perhaps more noted, in survivors of combat and natural disasters, it can also occur in patients who have overcome a health crisis (cancer survivors, HIV/AIDs patients, etc.). It was originally identified in the 1960s in survivors of the Holocaust and since been re-categorized as a symptom of Posttraumatic Stress Disorder.

Treating the Whole Patient

Because we don’t usually think of health crises as causing PTSD, the guilt and other mental health conditions that accompany these situations are often left untreated. I was treated for my stroke physically, but not really mentally, except in the capacity that it affected my actual cognitive abilities. I was sent home from the hospital with prescriptions for blood thinners, seizure medication, and a whole host of other drugs to counteract the side effect of the other two (despite the fact that I had not exhibited any of those side effects). Yet no one asked how I was dealing with the emotional side of what happened to me.

And it’s not just stroke survivors that have trouble processing what happened to them.

Depression is 3 times more common in patients after a heart attack than in the general population, with 15% to 20% of heart attack victims qualifying for a diagnosis of major depressive disorder, and a far greater proportion experiencing increased levels of depressive symptoms.”

According to the Lung Cancer Alliance, 63.9% of lung cancer survivors have experienced feelings of survivor guilt.

“While survivorship is often portrayed as an over-the-moon, happy feeling that all people battling cancer set as their goal, many lung cancer survivors feel burdened by it, experiencing emotions of guilt, anxiety and stress.”

Yet it seems that once the physical body is out of danger, many patients, myself included, are left on their own to unravel the emotional impact—to make sense of the new and unfamiliar life in which they find themselves. Often this process can take years.

For example, this project I’m working on is a staggering reminder that I have survived while so many haven’t. Though my stroke was 10 years ago, it is difficult to read the stories and interact with the families of the women who were killed by hormonal birth control. It brings me face to face with questions I thought I had long ago answered. Why me? Why did I live while so many others did not? And am I doing what I’m supposed to with this life?

I really needed you.”

About a year after my stroke, I told my dear friend Jamie about what the nurse said. I told her how much it weighed on me, about the pressure I was putting on myself. Her response was beautiful and simple and a good reminder for us all. “What if you’re here because I really needed you not to die?” Mind blown. Maybe some survivors are supposed to achieve great things and change the world. Or just maybe our purpose is as subtle and as profound as being there for someone else.

That message was enough for me for a long time. But when I was contacted about working on this project, I knew there was a reason. This work is important. Women need to understand the side effects of hormonal birth control, the symptoms of a blood clot, and that their options are not just the pill or pregnancy. We need to start asking why life-threatening blood clots, emotional issues, loss of libido, weight gain, as well as many other side effects are considered “acceptable.” We need to hold the pharmaceutical companies to a higher standard. We need to value human life above corporate profit. We need to take women seriously when they discuss their medical concerns. We need to fully research women’s health issues. The entire paradigm of women’s health care and contraception needs to change. The conversation has been started. And I think I may be here to add another voice to it. The voice of a survivor.

 

Real Risk Study: Birth Control and Blood Clots

Lucine Health Sciences and Hormones Matter are conducting research to investigate the relationship between hormonal birth control and blood clots. If you or a loved one have suffered from a blood clot while using hormonal birth control, please consider participating. We are also looking for participants who have been using hormonal birth control for at least one year and have NOT had a blood clot, as well as women who have NEVER used hormonal birth control. For more information or to participate, click here.

Patients Are Not Statistics: The Case for Personal Stories in Medical Research

2400 views

Lucine Health Sciences and Hormones Matter have begun an important new research project to investigate the relationship between hormonal birth control and blood clots. They are surveying and interviewing women and the families of women who have suffered blood clots while using hormonal contraceptives. A big part of this study includes publishing the personal health stories of these women. (You can read my story here.) Hormones Matter has always been a place to question the status quo in healthcare and believes that one of the most powerful ways we can do that is by allowing patients to have a voice.

Patient stories, or case studies, are vital to the conversation about the safety of medications and they help drive research about health issues. I believe they are the proverbial canary in the coal mine. How else will doctors and researchers know what’s going on? Should they rely solely on the drug companies to share information that may be detrimental to their bottom line? I don’t think so, but over the years many doctors and scientists have dismissed patient stories as anecdotal and therefore not pertinent to the research conversation. They claim that the only valid forms of medical research are the double-blind placebo controlled trial or the large epidemiological investigations and nowhere is there room for the patient experience of his or her symptoms. But these studies are often cost-prohibitive or take many years (sometimes decades) to complete. What about the patients suffering now?

Case Studies Dismissed in Hormonal Birth Control Research

In my research involving birth control safety and the politics and policies surrounding hormonal birth control, the disregard for patient experience, let me rephrase that, human experience, is striking and entrenched. Even back in 1970 at the Nelson Pill Hearings, Dr. Joseph W. Goldzieher, one of the physicians testifying, was so adamant that case stories had no value that he impugned the entire British Medical Journal, the official publication of the British Medical Society and counterpart to the Journal of the American Medical Association. His claim was based on their willingness to publish an article about cervical cancer and the birth control pill when he felt that other journals “would turn it down as proving nothing.” Perhaps it is no coincidence that the British Medical Journal was the first to call attention to the problem of blood clots and the birth control pill. Dr. Goldzieher’s testimony is as follows (from page 6375 of the Nelson Pill Hearings).

Senator McIntyre: Does this statement, the statement that this journal—I am now referring to the British Medical Journal—this journal is noted for its lack of editorial discrimination, represent simply your own opinion, or is it based on some evidence?

Dr. Goldzieher: No, sir. It is my opinion exclusively, and it is based on the fact that this particular journal publishes large numbers of letters of an anecdotal nature, which are perhaps amusing, but are of dubious scientific merit, but which are then used for purposes which are not admissible. Having crept into the scientific literature as information—any statistician would call it anecdotal information—it then gets quoted and re-quoted. This is of questionable value to the medical community.

Senator McIntyre: Doctor, is it not true that letters to medical journals might very well be a manner and a way of detecting problems that may be occurring?

Dr. Goldzieher: I think there are better ways, Senator… This raw information should not, in my opinion, appear in a journal of this type… It should go to somebody which knows what to do with this information. Printing it in the British Medical Journal is no way to handle this kind of information.

Of course statistics are important. And of course we cannot make claims for all women based on the experience of one, or even a few, but in the case of hormonal birth control and blood clots (or really any of the side effects from hormonal contraception or other drugs), we are not talking about a few exceptional cases. Hundreds of thousands of people are harmed every year from medication adverse events. In fact, prescription pharmaceuticals are the fourth leading cause of death in the United States. How hormonal birth control contributes to that risk is unknown. We see from the testimony of doctors, scientists, and researchers that even in 1970 the drug manufacturers knew there were far more side effects with synthetic hormones than had been studied prior to their approval. Imagine what might have happened if more case studies were published instead of dismissed as anecdotal. Would that have driven more research and more awareness of risks?

Case Studies Drive Research

A doctor that testified after Dr. Goldzieher completely refuted Goldzieher’s stance on case studies and the British Medical Journal.

Dr. Philip A. Corfman said (in Nelson Pill Hearings, page 6400.):

“I believe the thromboembolism story provides a good example of what kinds of studies are needed. The story started with clinical observations, letters to the British Medical Journal, and case reports in Sweden and American literature. These observations brought this problem to the attention of medical science, but it was not for several years, five or six at least, until well-designed, carefully controlled studies were undertaken to show that there is indeed a positive relationship between the use of pills and [blood clots].”

 

“We are still in the early stage with the other problems that have been discussed, such as cancer, hypertension, and diabetes.”

Clearly, it takes patient stories to help detect these problems. We cannot afford to wait for an observable statistical jump in the mortality of young women or any group of people before we start investigating whether these medications are really safe. We really cannot trust the drug manufacturers to make this decision for us.

Pharmaceutical Companies Against Case Studies

Perhaps it is no surprise that when Senator McIntyre asks Dr. Goldzieher if he had ever worked for the drug companies, his response was, “I am a consultant at various times to various drug companies.”

So maybe it boils down to Dr. Clark’s testimony upon being asked if he would give his daughter the pill.

“There are two sensible answers to that. The first is, my daughters are both college age now and they would not do anything I told them to anyway. The second answer, I think, is that in a survey such as this, one is dealing with statistics. These have to be looked at in the light of a group of other statistics. When you come down to a question of the patient, that patient is no longer a statistic.” -Nelson Pill Hearings, page 6152.

Patients are Not Statistics

Patients are NOT simple statistics. This is why sharing personal stories is so vital and why we make that a priority at Hormones Matter. The manufacturers and many astute doctors and researchers knew over 40 years ago that hormonal contraceptives needed much more research. In 2016 we still don’t fully understand the risks for deadly blood clots and other serious side effects. Had women not been silenced then, perhaps we’d know more today; perhaps fewer women and their families would suffer the consequences of hormonal birth control related blood clots.

Real Risk Study: Birth Control and Blood Clots

Lucine Health Sciences and Hormones Matter are conducting research to investigate the relationship between hormonal birth control and blood clots. If you or a loved one have suffered from a blood clot while using hormonal birth control, please consider participating. We are also looking for participants who have been using hormonal birth control for at least one year and have NOT had a blood clot, as well as women who have NEVER used hormonal birth control. For more information or to participate, click here.

 

A Stroke from Hormonal Birth Control: Part 2

3548 views

When I was 28 years old, I had a massive stroke (a cerebral venous thrombosis in the sagittal sinus area) from a combination of birth control pills and a fairly common clotting disorder, Factor V Leiden. You can read the first part of my story here.

Recovering from a Stroke

The repercussions of what having a stroke meant began to sink in after I was moved out of the intensive care unit.

Once in a regular hospital room, a therapist came by to do some tests. She pulled my blankets aside and asked me if I could take off my sock. This test seemed ridiculously easy, but I was willing, just happy that my head no longer hurt. I leaned forward and confidently pulled the sock off my foot. “Great,” she said. “Now put it back on.” So I put the sock back on my foot. Only I didn’t. Because I couldn’t. I stared at the sock in my hand and then I stared at my foot, knowing that I should be able to complete such a simple task, yet unable to.

This was the first of thousands of tests during my recovery. And it was the first of a thousand times when I knew I used to be able to do something that I could no longer do. It is one of the strangest sensations I have ever experienced.

I spent a week in the hospital and another week in an in-patient rehabilitation facility. Before I was discharged to go home (for another month of out-patient rehab), the psychologist told me that things would feel like “Christmas at the mall” instead of say, an ordinary Tuesday afternoon. It was an appropriate analogy for how overwhelming everyday life would be and one that I would come to understand the first time I broke into sobs when I dropped a bowl of cereal on the floor. I was cautioned against trying things like swimming alone, as I might not remember how and accidentally drown myself. They also told me that I had lost millions, maybe billions, of brain cells that I would never get back. And that I might never be able to work a “real” job again.

At home, I set about re-learning things like how to hook my bra, tie my shoes, and wash my own hair. Once I mastered these, I began to wonder what else I could do. I was extremely lucky that I made progress every day, but some days it felt like I’d never be back to normal. I wasn’t sure what normal even was anymore. After the warning from the psychologist, I was scared that I wouldn’t be able to handle a full-time job. And because of the seizures, I could not drive for six months which was devastating and isolating, especially for someone as independent as I had always been. Since I was stuck at home, it seemed like a good time to force myself to relearn math (yet another thing I knew I had been good at but could no longer do). I began to study for the GRE and less than six months later, I was accepted to graduate school.

Searching for Answers

When it came time to write my thesis, I decided to use my stroke as an inspiration for my research. I wanted to know why I had had a stroke, why no one had ever told me the risks involved with taking hormonal birth control, why I never knew there was a possibility that I had a clotting disorder which would greatly increase my risk. In short, I was looking for a smoking gun; someone or something I could point my finger at and say, “Aha! That is where the breakdown occurred. This is who should be blamed!”

But what I found was much more complicated. What my doctors had told me, that I was an anomaly, seemed to be supported by the research that I found. Studies show that most people get a blood clot within a year of starting hormonal birth control. Mine happened 10 years later. I learned that Factor V Leiden is fairly common but that women aren’t tested for it before being prescribed hormones because testing that many women would be expensive. I also found research that said pregnancy is more dangerous than birth control.

Putting aside the false dichotomy that the only two choices a woman has are to be pregnant or be on hormonal birth control, the message I took away from all of my research was that my stroke was an acceptable risk to save countless women from pregnancy. That even though my stroke could have been prevented by a simple blood test before I was even prescribed birth control pills, my value as a human woman was not worth the greater expense. As a child of the 80s and a product of American capitalism, this didn’t shock me as much as it probably should have. After all, I lived in a world of the Ford Pinto. What I didn’t realize at the time and would only come to understand years later, was that I began to internalize the blame for what happened to me. Maybe it was my fault for not knowing the dangers, for not understanding the risks, for being so stressed out that my body failed me.

Was It My Fault?

In researching my thesis, I discovered that pharmaceutical companies intentionally make the risk communication in advertising, and especially in the package with the birth control, dense and confusing. And I also found that women who have taken hormonal birth control don’t adequately understand the potential side effects, nor do they even know the symptoms of blood clots. There is very little accurate information about clotting disorders online. Even if my situation was rare, these facts are extremely troubling. But what I have since come to learn is that my stroke was actually not so rare.

Recently I’ve been contacted by an amazing group of people; researchers, families who have lost their daughters to hormonal birth control, fellow survivors, writers, and scientists. They’ve helped make it clear to me that I’m not just an anomaly. As you can see from the other stories on this site, hormonal birth control has very real, very harmful risks. And we have lost far too many amazing young women to stand idle any longer. Our standard must be higher than accepting these women’s lives as collateral damage. Together with this group of health advocates, we are embarking on a journey to give women what they need-information to make the right choice for them. Because what happened to me was not my fault. It’s time to stop blaming myself. Yet even as I write these words, I still have some doubt. And that doubt shows me that I haven’t fully recovered from my stroke yet. I still have work to do on this journey. And that work may take me the rest of my life. For more on what long-term recovery from a traumatic brain injury looks like, see Part 3 of the series.

Real Risk Study: Birth Control and Blood Clots

Lucine Health Sciences and Hormones Matter are conducting research to investigate the relationship between hormonal birth control and blood clots. If you or a loved one have suffered from a blood clot while using hormonal birth control, please consider participating. We are also looking for participants who have been using hormonal birth control for at least one year and have NOT had a blood clot, as well as women who have NEVER used hormonal birth control. For more information or to participate, click here.