First Period

Last night Annika started her first period. We are staying at my Aunt Janet's home with a horde of women: my two teenage daughters, my cousins, my sister, my mother--and apparently everyone started to sync up. Annika's body must have wanted to join in the fun because I suddenly heard her holler from the bathroom, "Moooommmmmmm! Mom! Mom! I need you!" I immediately knew what was going on--as did the entire house. Not shy at all, Annie wasn't embarrassed in the slightest. If anything, she became extremely chatty and hyper. She was so ramped up that she couldn't sleep and eventually crawled into bed with Jason and me for the rest of the night. Growing up is such a strange space--officially a woman, yet still wanting to snuggle with her parents. 

I was the same age when my first period came; I would have been mortified to have my mother tell another soul. Even though my home was predominantly female, it felt dirty, secretive and shameful on a societal level. Fortunately we live in a different era where periods are openly acknowledged and discussed. While they still might feel a little scary or gross, my hope is that the shame and secrecy are less. Working as a Labor and Delivery nurse has certainly helped me feel more comfortable talking with my children about our amazing bodies in a positive way.

Is it strange that our culture doesn't have coming-of-age rituals to recognize or celebrate these transitions? Perhaps we ought. With Annika's special heart, I've given more thought to what a period really means. A period represents the continuation of life. Her body is showing us that it is thriving--healthy and strong and whole. For us, nothing is promised. Annika was just a girl when her heart first stopped. There were moments when we didn't know if she would ever make it to puberty. Now, thanks to her donor, she can join all of her girlfriends in conversations about cramps and pads and period undies.

It feels so...normal. There aren't many peers who can relate in a conversation about her tacro tremor or everolimus mouth sores. This time as her body changes, she can be welcomed by a sisterhood who acknowledges the discomfort and pain as healthy and productive. Periods may suck, but on some level they are also wonderful--only through them does new life come into this world.

But as is so often the case with transplant, the story becomes fiercely tangled. For Annika, childbirth is very complicated. Even if Annika could bear a child, should she? Would she pass on her TNNT2 gene variation, resulting in cardiac problems for her children? Would the strain of pregnancy and childbirth be too much for her transplanted heart? What about the risk of rejection? Given her lower auto-immune threshold, would her body reject a fetus as foreign? What about her transplant medications? Some are known to be extremely harmful in pregnancy. And even if Annika and her child both made it through childbirth safely, what then? The future is uncertain for all of us, but for Annie the grasp is tenuous. Before she was transplanted, her team was very clear that transplanted hearts for her age group last an average of 10 years. If Annika were to have a child, she would already be running on borrowed time. Is it ethical to have children knowing that you might not be around to raise them?

Most of the time I push aside these harsh thoughts by focusing on the miracle of Annika's current health. Writing this, however, brings me to tears. Annika used to tell us how she wanted twelve children. It breaks my heart to realize that she may never any, at least in this lifetime. 

That first tentative smear of blood, full of both promise and pain. The hope of life and tears of an empty womb. Annie's first period.