Crestone to Corée

Emmylou sings about blue memories stretching hundreds of miles like a cord pulled tight. Hundreds of miles have become thousands for us, and now, in death, what? Light years? Quantum leaps? (How far is an eternity?) The Green River Gorge becomes Crestone becomes quarantine time in South Korea, and I suppose, my “Boulder to Birmingham.”

I don’t know how you died. I’m only notified by your family that you did. So in your honor I scaled a snowy path up to a sandstone stupa—the proper container for a great teacher—in Crestone, Colorado. The receptacle can hold ashes and small bones of a body or religious relics, such as paper scrolls where mantras and bodhisattvas’ names are written. Crestone is believed to be an energy center, a spiritual vortex, like Sedona, or your Asheville, as you once believed. Tibetan prayer flags fluttered in the winter wind that day. A spring cusp sun burned through the clouds. You were everywhere. In South Korea, your gijesa would have been held last month—the anniversary of your death. I think of you as families trim the grasses on their ancestors’ gravesites and bow deeply. 

I call a mutual friend I have been too afraid to call. I don’t want to call her because I know once I do I will crack wide open and my heart will spill over like soured red wine. But when I do, my mouth freezes against the phone: important words marbleize in the back of my throat. In the past when I shattered, I wanted someone to help sweep me up, hug me, and say, “You just needed a little attention.”  Am I too old to throw a tantrum now? A question you would’ve been able to answer. 

In South Korea the burial mounds aren’t faced with stone. I think of separation. I think of The Stone of Unction in The Church of the Holy Sepulchre where Jesus’ body was laid down and prepared for burial. I think of how the Russian pilgrims smeared their hot pink lipstick across its red marble face. They just wanted to kiss God. The closest they would ever come to a body. I remember standing apart, aloof, waiting to be invited first. Perhaps I still am. But in South Korea burial sites are unassuming grassy knolls that can be stumbled upon in the woods. Their religious artifacts are commonplace. Apples, kimchi, and bottles of Soju are left behind like a picnic basket for the afterlife. There is no formal separation between the living and the dead. 

I am failing. I have forgotten everything you taught me. I am not being present. I am not being brave. Instead of learning Hangul, I am re-learning French. Korea becomes Corée, not its native Daehanmingug. I avoid Buddhist temples, though they are bountiful and beautiful. I am afraid to walk in. Again, I am loitering around God like a drunk outside a liquor store. I am sending mixed messages to the multiverse, like your invented mudra of emotional inertia: a person holding up both hands—one beckoning, one halting. Come close, but not too close.

I don't know how you died. Your family only said there would be no service. On the Internet I found a two-sentence obituary published by the National Cremation Society. Your Facebook page was silent. For me, not knowing feels like a missing body. Your obituary felt like a crime. 

At the Wailing Wall in the Old City eight years ago, I tucked a folded prayer into a stone seam. Being very tall, pilgrims passed their notes to me so I could wedge them high on the wall. They would last longer there. On my petition, I listed the names of the most important people in my life: children, parents, and closest friends. My soul mates, my wound mates, my twin flame. Your name is written there. 

DIY Delivery: Part II

The mountains are dusted in white, so we know it must be spring. Cherry blossoms adorn hillsides like sprigs of baby’s breath, green buds burst forth, ducklings hatch, and crocus bulbs cleave. As I witness these spontaneous births across South Korea, I can’t help but think of our own daughter’s unpredictable debut 3 ½ short months ago…

Years ago when I was in labor with my first child—cervix 10 cm dilated, baby’s head crowned, my body readied to push—I was told to hold back my son for almost 30 minutes as we waited for my OB-GYN to arrive. Being very young and my first delivery, I dutifully did as I was told. But to this day I still don’t know how. It felt like one of The Five Chinese Brothers trying to swallow the sea: completely unnatural. The first time I saw Saemangeum Seawall in South Korea I thought of this children’s book as well as this memory. The 21 miles long dyke is a 2 billion dollar land reclamation project, converting 150 square miles of tidal flats into arable farmland. At low tide fishing boats and crab traps look like shipwrecked derelicts in the salty wasteland. In my imagination, I can see the disobedient little boy of that children’s book running off into the horizon, chasing after briny treasures, as the poor Chinese brother struggles to swill the ocean in his mouth. Ultimately, the brother fails. The dammed water breaks and the little boy drowns. In my first labor, I felt this same overwhelming pressure. Perhaps my second son was born so quickly because of it. 

These are two concerns I carry with me into my third delivery: doctors dictating my birth story and not making it to the hospital in time. So when my OB-GYN announces he will only allow me to labor a maximum of five hours before initiating a C-section, my husband and I decide to leave the practice. Despite telling him about my large babies (both nearly ten pounds), my quick deliveries (both under six hours), and my desire to avoid both induction and C-section (if not medically necessary), he is uncomfortable with my baby’s size and a natural delivery. At 40 weeks, we transfer to a university teaching hospital almost an hour away. The distance scares me as I imagine a roadside delivery. The loss of my relationship with Dr. Um depresses me, as I begin a sudden one with our new doctor—the one willing to give us more time. I knew delivering a baby in a foreign country would have its challenges, but I’m starting to feel more anxious about hospital policies than the birth itself.

Everyone makes guesses about when the cherry blossoms will appear. Mid-April. Before Passover. After Easter. When the virus passes… It feels like waiting for our baby girl to arrive all over again. We look for the tells—warmer temperatures, succulent buds, news reports from the subtropical south—as we eagerly anticipate the explosion of pale pink flowers. Back in December, as our baby demurred, we tracked labor sign in much the same way, hunting for creaky joints, a dropped belly, or a bloody show. And as we waited until the limit of our induction date—42 weeks—new fears supplanted old ones. I no longer worried about a fast delivery or a doctor who ran late. I worried about my aging body—one that might no longer have the hormones to kick-start a labor or the muscles to push out a baby. But I tried to remember that birth is as unstoppable as spring. 

The night we are supposed to go to the hospital to be induced at 42 weeks, I’m feeling funny. It may have been 22 years since I last gave birth, but my memory for labor is indelible. We want a natural delivery. We want the fewest medical interventions possible. We want a little control. And so we decide to wait and travel to the hospital once the contractions are ten minutes apart. While our new doctor has promised to give us more time in labor before calling a C-section, we feel a little snake-bit by the system. Before we worried about arriving too late; now we worry about arriving too soon. Unlike my previous fast and furious births, this labor is lazy and light. Contractions remain 30 minutes apart for the entire next day. But when they finally narrow, I’m confident my body is well on its way. We leave in the evening, even stopping off to look at puppies and have a light meal first. We are circling the hospital parking lot as we calculate the timing of my contractions, always keeping that “five hour labor window” in mind, and feeling annoyed we even have to “game” the system this way in order to have a natural delivery. 

A few months after I deliver my baby girl, in the height of the COVID-19 crisis, I will sign a petition online to prevent hospitals in the United States from banning the support person in the delivery room. It’s an unconscionable proposal. More than just a hand to hold, the support person in the delivery room is oftentimes a laboring woman’s only advocate. I know my birth story would have read very differently if my husband hadn’t been in the delivery room that night. In fact, I know the hospital staff didn’t want him to be. 

At check in, we are informed that my husband will not be allowed in the delivery room. I was mentally prepared to not have my mother or friends near me during this very important time, but my husband too? At the Woman and Baby Center with Dr. Um, we had discussed our birth plan—my husband in the room, waiting 5 minutes to cut the cord, the hope of a natural delivery—so we wrongly assume this modern facility will follow suit. After many minutes of wild hand waving and language app translation, where my husband insists on either his presence or a suggestion as to where we should deliver our baby—in the ER? on the street?—the admitting staff relents. My husband is allowed to be with me. However, staff will continue to try to lock him out, as he hammers on doorbells, tries to sneak in through side doors, and considers going Mission Impossible as he looks up at a ceiling access hatch.

Looking back now, we laugh at the absurdity of the situation. We even laughed quite a bit that night at the funny things about delivering a baby in South Korea. Funny things, such as the drops of dried blood on the floor and hospital bed from the previous patient. Even as we point them out, the sheets remain unchanged. I simply lean away. Funny things, such as a nurse telling me to clean up my own hair after she shaves me. I try to joke with her I haven’t been able to see that region for a couple of months, but okay, where are the Kleenex? Her response: You didn't bring your own? Or when I try to get up to use the toilet, and she tells me to use a bedpan. I ask: Where is it? Again, her reply: You didn’t bring your own? Which brings us to the next funny thing: It’s BYOMS (Bring Your Own Medical Supplies) in South Korea. Upon admission, they hand my husband a list of supplies needed for the delivery: Blue Chux underpads, large sanitary napkins, bedpan, urine bottle, sitz bath, that box of Kleenex...  You purchase everything at the 7-Eleven in the hospital—one of the many small errands my husband goes on resulting in yet another lockout. The following morning it’ll be BYOC (Bring Your Own Chopsticks) for your seaweed stew, but our roommate (one of at least 6) will loan us a spoon.

But what isn’t funny is the continued pressuring to have the surgery. Even though my husband declines the procedure multiple times, as soon as he leaves the room, they push the paperwork in my face again to sign off on a C-section. When I ask about my dilation, they tell me I’m not making progress—even as we eye high peaks on the computer screen. I know I’m feeling at least 4cm quality contractions, but when I point to the evidence, they turn off the monitor. My husband pokes at random buttons on the cardiotocograph until the printer spits out a hard copy; the nurse promptly returns and tears it up. My husband and I are utterly bewildered, and so he hunts down someone to turn the monitor back on. They finally do. The baby’s vital signs are normal and steady. The contractions are regular and intensifying. Everything, based on my experiential knowledge, feels textbook. But I’m starting to doubt myself, and as I labor blind, I wonder if I’m succumbing to paranoiac thinking. 

They finally leave us alone. A nurse makes one last attempt to get me to sign off on an epidural and episiotomy. I refuse both, having had neither in my previous deliveries. She leaves frustrated, after drawing detailed pictures of the episiotomy and tapping her pen vehemently on a cartoon anus. In this way, South Korea’s obstetric system is similar to America’s in the 70’s. My mother said it was standard back then to be shaved, drugged, and cut, regardless of what the patient wanted. We were halfway into the haircut earlier before I realized this was protocol. But we are left maybe too alone now. I labor intensely and keep wondering where I’m at. No one checks on me for a couple of hours, so I finally ask my husband to find someone. When they finally check me, they say I am only 2cm. I know, to the core of my being, this is wrong. I request to be re-checked. Suddenly, I am now 6cm. This happens again an hour later when, once again, my “advocate” has to seek out help. Based on my pain, I’m certain I’m almost fully dilated. Again, they say I’m only 6cm. Again, I request to be re-checked. All of a sudden, I am at 10cm and 3 nurses and 2 attending doctors pour in. Later I will learn the doctors were on standby for an emergency C-section.

They say all’s well that ends well, and that is certainly true for our birth story. Our baby girl is born without complication and, at 9 pounds 14 ounces, is a superstar in the nursery. Babies this large in South Korea are so rare, in fact, that they want to put her in the NICU for observation. My husband—who has followed after the baby into the nursery--laughs and declines. She is 3 ounces heavier than my first son was and 1 ounce lighter than her father was.  She is born on the first night of Hanukah, which is meaningful to my Messianic Jewish husband.  

As I sit here on Easter eve thinking about what I’m grateful for—second chances, new life, a recommitment to my spiritual life—I also think about the blessing of that experience in the delivery room. While a hard won natural delivery, I’m still grateful for the vigilance of South Korea’s national health care system. Ranked first in the OECD for healthcare access, South Korea has, in the end, taken very good care of us. They delivered our baby girl, protected us from COVID-19 with their highly effective trace, test, and treat program, and detected our daughter’s Ventricular Septal Defect, providing her with immediate care.

When our daughter is almost two weeks old, I take her to see Dr. Um. While there were no hard feelings between us when we left his practice, I still feel nervous for some reason. But just as the front desk staff starts to fawn over the baby and boggle at her size, Dr. Um emerges from his office, rushes towards us, and lights up like a sunrise.  

DIY Delivery: Part I

I knew it would be a different experience. I knew—22 years later—it would be harder. I knew, at my advanced maternal age, I would be picked and pored over by perinatal specialists with their genetic tests and nuchal translucency ultrasounds. But I never, in a million years, knew I would become a problem patient at the mercy of the South Korean medical system. 

I’m reading Pearl S. Buck’s The Good Earth for the third time. In fact, by the end of my first month in South Korea, I will have read every Buck book available in PDF online:The Good Earth, Sons, A House Divided, East Wind, West Wind, and The Mother. I imagine the scene where Wang Lung’s wife labors alone—locking herself in their tiny bedroom, pulling out the birthing stool, leaning hard into the packed earth floor. She’d wipe the sweat off her brow, bite into a strip of leather to stifle her screams, and catch her own baby. If it had been a morning delivery--and her second or third child--she might’ve returned to the fields by mid-afternoon. And so our emergency birth plan becomes a running joke as the weeks tick by: the proverbial squatting down in a rice paddy.

The joke has merit. 22 years ago, I delivered my second son in less than four hours. My OB-GYN back then had quipped my third child would probably be delivered in the backseat of a cab. I think of my third child now. Who knew her “back seat of a cab” would mean a birth abroad? In August, the rice fields are a waving green sea and our humor is high. The grasses seem soft, small cabbages crown like baby heads, and fig trees are heavy with fruit. But by late fall—as we move closer to our December due date and I start to worry about a fast delivery—the fields lie fallow, and the barren, brown rows depress me. 

We keep a running list titled, “Funny Things About South Korea.” For example, public trash cans on the street are rare, toilet paper is often on the outside of the toilet stalls (God help you if you forget to grab a handful on the way in and are already well underway before realizing it), and delivery drivers on scooters are near homicidal as they run red lights and side swipe you on the sidewalk. But second to scooter scares, I am most shocked by this one funny thing: any small piece of earth is fair game for a garden. Scallions, leeks, and lettuces sprout up in the most unlikely places—an empty lot next door to a 7-Eleven, the periphery of a trash pile, the blank spaces between old railroad ties. Highway medians, easements . . . even the foundation of an abandoned house is seemingly tilled, turned, and terraced overnight. Nature’s tenacity gives me great comfort though. As my baby unfurls in my womb, I imagine my little girl must have found a tiny patch of healthy tissue to burrow into and grow. And just like sunflowers turning their heads towards sunshine, nature is just doing what nature does best: following its instincts. 

The South Korean medical system’s convenience is a pleasant surprise. Appointments are rarely set. “Just come back,” is always front desk’s answer when I ask about making one. Cost is also surprising. A prenatal appointment runs anywhere between $20-60 and includes any routine blood tests, glucose screens, or ultrasounds. As we have global insurance, we always pay cash up front and submit our receipts later for reimbursement. Initially, we are nervous about the pay up front delivery cost, but hospitals quote us anywhere between $2-5K, depending on natural or caesarean birth (a fraction of the cost in the US). In the states, and even with good insurance, my office co-pays alone were $40, my first trimester perinatal appointments totaled over 10K, and my genetic panels ran 2K. So, at first, we are pleased with our new care. I walk two miles to my doctor appointments and look forward to them. My OB-GYN, Dr. Um, is a tiny man with a smile like the sun coming out. I walk into his office and he cries out, “Jennifer Nance(ee)!” (Koreans always pronounce an extra “ee” sound on words ending in “e.”) Between his broken English and my Papago App Hangul, we discuss my condition of “old age(ee).” He is happy with my progress. From my weight gain to the baby’s development, everything is fine.

Fall turns and Koreans honor their ancestors and equinox with a three-day holiday weekend called Chuseok. Burial mounds are visited and tended. Harvest season is celebrated. Rice wine is drunk. On Monday, a Korean co-worker, Mr. Won, returns bearing gifts for our family: fresh persimmons, dried seaweed, and Asian Pears as big as softballs. Koreans encourage me to eat fresh fruits and vegetables and to look only at beautiful things: an old wives tale that promises a pleasant child. Our baby is now as big as a head of cauliflower and weighs almost 4 pounds in utero. And this is the first time my doctor expresses concern. Despite my reassurance that my previous two children were big babies, that both my husband and I were big babies, that I—standing at almost 6 feet tall—am still a big baby, my doctor shakes his head. He’s concerned about gestational diabetes, shoulder dystocia, and the possible need for a caesarean delivery if the baby exceeds 9 pounds. He says he will try to induce me first at 40 weeks. The limit. I’m due December 8^th, but I have a secret wish this baby will come early on Thanksgiving, my late grandmother’s birthday. So I am not worried. Yet. 

In South Korea 45% of all deliveries are by caesarean section. With the lowest birth rate among OECD countries in the world, this high C-section statistic is due in part to litigation fear, mother preference, and doctor recommendation. Korea’s National Healthcare system has also made vaginal deliveries so cheap that OB-GYNS are encouraging the more profitable surgical delivery just to financially tread water. And because the South Korean medical system is largely paternalistic, a doctor’s directive, “Because I said so,” is usually heeded. Female patients rarely question their doctors, and their husbands—who could speak up for their wives—are rarely allowed in the delivery room, especially for C-sections. These overprescribed C-sections have become, according to an article in the Korean Medical Review, a "cesarean epidemic."  While medically necessary in high-risk pregnancies and complicated deliveries, South Korea has seen an uptick in elective C-section deliveries among young women in their 20s and 30s. This data alarms me. While I know I'm not young, I also know I'm not a high risk patient. My doctors in the US assured me I could attempt a natural delivery if there were no complications, so I'm nervous about being pushed into an unnecessary surgery. However, I'm not reckless. I realize that even though my first two birth experiences were uncomplicated, natural deliveries, they were also lifetimes ago. I know I need to mentally prepare for this scenario; I just don't want it to be a foregone conclusion. Why not give my body a chance first? But when I  propose a birth plan very different from my doctor's, the conversation doesn’t go as planned. 

Thanksgiving passes by like a stranger. We cook the special meal for a mixed gathering of Koreans and servicemen, and while the room is cinnamon warm and friendly, one guest is conspicuously absent. Our baby marches toward her deadline, thickening daily like a cover crop of rye wheat in winter.