This fuzzy forties photo shows something of the stress my mother was under when I was born. By nature she cannot but admire her firstborn child, but her baby doesn’t look well, and her concern and anxiety are clearly outweighing her maternal pride.
The forceful and uncontrollable vomiting that is a signature sign of pyloric stenosis (PS) developed very soon after the birth which is in itself a very stressful as well as a joyful time, even more so when it’s a totally new experience.
PS is a condition in which the doughnut shaped muscle at the stomach’s exit becomes so swollen that food can no longer pass. Why is still a mystery. After the mother’s milk has been processed in the stomach for a while, it cannot pass on and is expelled in powerful spasms that can send it fountaining 2 or 3 metres away. Spectacular but terrifying – especially when it’s your own newborn flesh and blood doing this.
The obvious thing mothers do after this happens the first time is to give another feed: just slow the drinking, take more frequent breaks, let the little one burp more, and hold the baby more upright. Same result. The vomiting typically occurs intermittently at first but happens with increasing force and after every feed, sometimes over one day, sometimes over a few, or even weeks. How worrying is that? The baby stops making dirty and then wet nappies (diapers), and starts to lose weight and then condition. In the most serious cases, the baby’s skin becomes wrinkled and sunken, and it just sleeps. I was shown my weight chart once and it shows a very marked drop in weight, followed by a steep rise after I had the surgery.
The textbooks tell us that PS most commonly develops between 3 weeks and 3 months; I must have been a very early and rapidly developing case as I was on the operating table at 10 days. Pyloric stenosis comes with considerable variety. I’ve read of some cases that developed even earlier than 10 days, whilst others reports describe a chronic but mild and manageable form throughout the childhood and teen years. Most babies with ps are rushed off to the operating room after diagnosis and stabilising their hydration and blood biochemistry: surgeons say they love this operation as “a simple, elegant and quick fix”.
However in some countries ps is dealt with more conservatively and gently with a course of medication that reduces the swollen muscle over several weeks. Studies have shown that 75-80% of PS cases can be successfully handled this way, which would have had a better outcome for many of us who take years to come to terms with the often hidden trauma of infant surgery and their feelings about having a prominent surgical scar about which they had no say or recollection.
The Hippocratic Oath requires that medical professionals seek to help their patients, surely in the immediate but also in the long term. I and many others have found that surgery that is “elegant and quick” from an immediate and narrowly medical viewpoint may not necessarily be in the long-term best interest of patients and their families.
My mother would or could never bring herself to talk about the life-saving surgery I had so early. I wrote about her evasive silence recently. My PS had obviously marked her deeply and painfully. In time I will write more about the pressures on my parents and particularly my mother – those linked with my illness and others in their background but still very real back in 1945.
Curiously, Mum’s own trauma added a word to her vocabulary: often when she came across a small object that was strange or a child acting in a childish way, she would call it a “funny pierelore”. Whenever she used that word my heart would skip a beat… I wonder why!