Health
A Stitch in Time
Sterilization is a safe and easy method of birth control. The hardest part is deciding to do it.
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The first incision, just one-fourth inch long, is made slightly under the navel. The few trickles of blood are quickly wiped away. Through this small opening the doctor inserts a hollow, double-walled needle, known as a Verres needle, which is connected to a large tank of carbon dioxide beside the operating table. Turning on the flow, he gently inflates the abdominal cavity like a balloon. The approximately three liters of carbon dioxide raise the abdominal wall three or four inches above the internal organs, allowing an unobstructed view into almost the entire lower portion of the torso.
With a machine monitoring the flow of CO2, the physician widens the incision a bit. Then, with a well-controlled thrust, he inserts the laparoscope through the tight, narrow opening into the cavity. Attaching a telescope and a fiber-optic bundle (which produces a cool light that will not burn body tissues), he scans the internal organs, occasionally removing the eyepiece and dipping one end in a heated saline solution so that it won’t fog up—like a cold windshield—in the warmth of the patient’s body. After making the second incision in the shaved patch just inside the pubic hair line, he inserts a tube to accommodate the surgical instruments.
Illuminated by the bright light of the optical fibers, the interior of the human body is strangely beautiful. More than anything else, it resembles an undersea garden: anemones, corals, and exotic ocean creatures. The intestines are smooth and pink, the liver a rich burgundy brown. Fat reclines in liquescent gold globules. Hugging each white ovary is a pink fallopian tube, which snakes off to join the coral-red uterus some two inches away.
After scanning the abdominal cavity, the physician inserts a pair of long, specially designed forceps through the lower tube. While looking down the scope, he grasps the first fallopian tube about an inch from where it joins the uterus. Pressing a foot switch, he turns on an electrical current, which passes through the forceps and in an instant neatly cauterizes and seals the tube. With each pulse of electricity, a barely audible “zap” is heard. The current is on for no more than three seconds altogether. The doctor then snips the center of the cauterized area (some physicians don’t cut at all; others seal two areas and remove a section of the tube) to be double sure that neither sperm nor egg can pass. When the first tube is finished, the second is treated in exactly the same manner.
An alternative method of sealing off the tubes is to place a small plastic band, called a Silastic ring, around the tube to squeeze it permanently shut. Although it is only slightly less effective than cauterization as a means of contraception, it has advantages that some patients and physicians feel outweigh its drawbacks. The biggest advantage is that unlike the electrocautery method, it carries no risk of accidentally burning the lower intestine, thus necessitating a regular operation to repair the damage. Its biggest drawback seems to be that in a few cases it causes some persistent abdominal and lower-back discomfort.
In both methods there is a risk, again very small, of hemorrhage or that internal organs or blood vessels may be perforated by the laparoscope, the inflation needle, or the cannula that is inserted into the uterus. Despite all of this, the operation is extremely safe. Each year 600,000 women undergo tubal sterilization in the United States. In 1976, the most recent year for which figures are available, major complications occurred at a rate of fewer than three per thousand. The death rate that year was four per hundred thousand; in 1975 it was zero.
Once a woman has been sterilized by tubal laparoscopy, the chances of her becoming pregnant are negligible; the operation is 99.94 per cent effective. Although rare, a few pregnancies, both tubal and normal, have occurred, apparently when an egg or a sperm managed to migrate through a small break in the seal and, miraculously, leap the gap between the two ends of the tube. (Incidentally, more tubal pregnancies occur with the Silastic ring). Such cases make headlines and lawsuits, but in the vast majority of cases sterilization is permanent and complete.
When the tubes are sealed, the operation is all but over. The laparoscope is removed from the abdomen and the carbon dioxide is allowed to escape through the incisions. The surgeon swiftly closes them with four small stitches each, Band-Aids are applied, and the nurses lift the patient onto a stretcher for the short trip to the recovery room. The time elapsed from beginning to end of surgery is less than fifteen minutes.
Back in my room, after groggily coming to in the recovery area, I found that while I didn’t exactly feel good, I didn’t feel bad either. The sharp pain of the fresh incisions quickly subsided, and I felt nauseated from the anesthesia only if I moved too quickly. It was good to hear the nurse say, “Everything went fine; she did great,” better yet to have Tim, who was waiting for me, hold my hand. Regaining consciousness was a gradual process, and I napped off and on while odd, disconnected thoughts drifted through my mind. Vaguely, I recalled the half-dozen female cats I had marched off to the vet to be spayed, to have them return home on wobbly legs, with a small shaved patch on one furry side. Strange how my empathy for them had suddenly increased.
In two hours I was alert enough for a slow walk around the hall, and four hours after returning from surgery I dressed, descended to the parking lot in a wheelchair, and went thankfully home, relieved that it was over and that everything had gone so smoothly.
The first three days after the operation were so uneventful as to be boring. A friend brought over a book and some flowers Sunday afternoon and was amazed to see how fit I looked; that evening Tim and I went out to eat. Basking in my new role as star patient, I was secretly astonished at my own recuperative prowess. The only discomfort I had was an ache in my shoulders and neck that, as the doctor told me, was actually pain from my still somewhat bloated abdomen, mentally “displaced” to another part of my body. It’s a common occurrence with this operation, and one Percodan tablet relieved it completely. But I noticed that the pills—or something—had started making me wakeful at night.
A couple of hours of lost sleep I could cope with, but eight hours of tossing and turning all Monday night made my mood change abruptly from cheerful to glum, and before I even got out of bed, I knew that something was definitely not going right.
The mind is so much at the mercy of things outside itself—sleep, drugs, the body’s own hormones, the weather—that it’s a full-time job staying on an even keel under normal conditions. Under abnormal ones, such as after an operation, one’s emotional equilibrium is decidedly off balance.
I hadn’t expected to be depressed. I certainly didn’t want to be depressed. But to my unpleasant surprise I found myself submerged in the blues, dredging out of my subconscious every scrap of regret I had earlier set aside.
For two days or more I hardly left the house. In fact, I hardly left the bedroom. I shifted from bed to chair to bed again, berating myself for my certainty about the operation. We could have had a child. We could have added a room on to the house. I could have exercised and gotten myself in shape. I could have had amniocentesis to be sure the fetus was normal. I could have quit my job for three or four years. It was all feasible. Why hadn’t I thought of the advantages of having a baby as thoroughly as I had cataloged the disadvantages?
Coaxed out of the house for lunch at a neighborhood restaurant, I spoiled everyone’s meal by snuffling and sniffling for 45 minutes over a perfectly innocuous remark Tim made. He was baffled. He couldn’t understand why, when everything had been going so well, it was now going so badly. And to be honest, neither could I.
On the third day of the siege, even though my mood hadn’t improved, I began to seriously distrust my emotions. Why was I doing this to myself? I had spent weeks thinking this through ahead of time. Everything I was crying over now I had carefully weighed before. Finally, on the fourth day of the depression, a flash of insight came—while I was brushing my teeth. Unlike great moments of self-knowledge in literature, my revelation was neither succinct nor poetic, but its very awkwardness was, to me at least, proof of its sincerity. In a sentence, the depression was the price that I felt society was exacting from me for making a rational decision about an emotional subject. Or, to look at it from another angle, I hadn’t been sorry enough that it wasn’t my lot in life to have children. And why this ritual regret? Why now rather than before? Simple. If I had put myself through all of this before the operation, I might not have gone through with it.
The mental relief this convoluted reasoning gave was immense and immediate. I slept that night. I went to work the next day. Best of all, I began to take an interest in things outside myself.
Looking back at it now from the distance of several months, I think my bout with depression was caused as much, if not more, by physiological stress as by my psyche. Any surgical procedure can cause emotional swings, and one that involves a woman’s reproductive cycle, which is notoriously subject to ups and downs, is a double-jeopardy situation. Now that considerable time has elapsed, all the scars have faded. The two tiny incision lines are all but invisible; I could wear a bikini, if I were so inclined, and no one would even notice them. My physiology is perfectly normal. My menstrual periods are as they were in my preoperative, pre-pill days, and my sex life is just fine. The only discomfort I still have is an occasional sensitivity in the lower abdomen, around the cauterized areas of the tubes, that comes on during my period or after sitting in a cramped position for a while. It has never bothered me enough to warrant even an aspirin, though, and it always goes away in a couple of days. I’ve heard of other women who say they can “feel” their tubes, but it doesn’t seem to be a universal result by any means.
As for my mental outlook, it couldn’t be better. Sterilization proved to be a watershed in my life: of other decisions I have made, only two—marriage and divorce—have affected me as profoundly. But now that time has passed and the results of what I did have meshed with the cycle of days and weeks and months that make up life, I am more certain than ever that the decision I made was right.
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