Tuesday, February 06, 2007

Is she really no longer your problem after she walks out the door?

From the National Abortion Federation Clinical Guidelines
Policy Statement: Most serious abortion complications are detectable in the immediate postoperative period. Appropriate and accessible follow-up care is essential to patients' well-being.

....

Standard 7: The facility must provide an emergency contact service on a 24-hour basis where calls are triaged in accordance with appropriate law. The facility must assure physician referral if indicated.

Just to make it clear: This is a "standard".
STANDARDS are intended to be applied rigidly. They must be followed in virtually all cases. Exceptions will be rare and are difficult to justify.


From the College of Physicians & Surgeons of Ontario:
The facility provides all women with verbal and written information on discharge. There is a 24 hour contact number through which a woman can obtain emergency care, both physical and psychological, for any problem arising relating to an abortion.


From Best Practice in Abortion Care:
Community-based abortion services must have such protocols to facilitate a rapid and appropriate response in emergent situations.

30 comments:

Tlaloc said...

Quick question: when were these guidelines first put together?

Answer: 1996 (read the introduction to the guidelines)


When did Carolina Gutierrez die?

Answer: 1995

You are faulting a clinic for not adhering to guidelines THAT HADN'T EXISTED AT THE TIME.

GrannyGrump said...

I used NAF's Clinical Guidelines because they typify what's expected of a properly operated abortion facility. The fact that this particular set was promulgated in 1996 doesn't mean that suddenly, in 1996, abortion practitioners had an epiphany and said, "Gosh! Aftercare! What an innovation! Why don't we start doing that!" Which you seem to believe.

The point -- which of course is lost on you -- is that it's considered the abortion facility's responsibility to have an after-hours number the woman can call to consult with problems. The purpose is twofold:

1. Triage. A medically trained person, familiar with abortion aftercare, can assess the woman's symptoms and let her know what is an appropriate course of action. This might involve having a physician phone in a prescription for her, instructing her to seek care at an emergency room, or making an appointment for a follow-up visit at the facility. If you do any research you'll see that this has been a standard for a long time.

2. Being available to medical professionals treating the woman. If she does go to the emergency room or another doctor, somebody can pull her chart and let the caregivers know what the results were of pre and post abortion tests and examinations, the course of the abortion, any medications she was given, etc.

This is not rocket science.

Tlaloc said...

"The point -- which of course is lost on you -- is that it's considered the abortion facility's responsibility to have an after-hours number the woman can call to consult with problems."

No. The point is that some clinics VOLUNTARILY choose to take on that responsibility. Frankly I think that's a mistake on their part but if they agree to it then they should abide by it. But it is not otherwise their responsibility.



"1. Triage. A medically trained person, familiar with abortion aftercare, can assess the woman's symptoms and let her know what is an appropriate course of action. This might involve having a physician phone in a prescription for her, instructing her to seek care at an emergency room, or making an appointment for a follow-up visit at the facility. If you do any research you'll see that this has been a standard for a long time."

This is exactly what's wrong with this idea. TRIAGE SHOULD NOT BE UNDERTAKEN AT A CLINIC! If the woman has symptoms after the abortion that are unexpected (and a clinic should certainly communicate what is expected to her) then she needs to be at a facility that can treat her. That is definitively NOT a clinic but a hospital. The clinic is only set up to do abortions, or even in the larger places like PP facilities OBGYN stuff. They are not emergency rooms. Not extended care facilities.

Why on EARTH would you ask a facility to do triage if their only recourse is to send you down the road to a real hospital who will of course have to start the process all over again?

Why would you do that when it provides absolutely no benefit? The hospitals have all the expertise of the cliinic plus more. They have vastly superior equipment. There is simply no reason to waste time by involving the clinic at all when they can do no good.

GrannyGrump said...

Tlaloc, I used to so ab/mal litigation support. I think I know better than you do what's expected from an abortion facility and when they're deviating from the standard of care. My familiarity with standards of care comes from having worked for the people lawyers called for help when they were pursuing a lawsuit against abortion practitioners.

My assessment of where their responsibilities lie is based on the real world.

You, on on the other hand, clearly just personally prefer that a clinic have no responsibility for patients after they scrape them out. But medical responsibility is not based on what Tlaloc personally thinks is reasonable. It's based on what the medical community has agreed is the standard of care. And shoving her out the door with a pat on the back is only adequate to people like you.

Tlaloc said...

"My familiarity with standards of care comes from having worked for the people lawyers called for help when they were pursuing a lawsuit against abortion practitioners."

It isn't your familiarity I question but your *impartiality.* You have been trained and used as weapon against abortion providers. And it shows. You choose to see every action, every motive, in the worst possible light. That makes you perfect for a lawyer trying to win a case but also makes you too prejudiced to be a fair judge. There is a reason in a court you have two opposing advocates and then an impartial middleman (judge or jury).

The problem is that even though you every instinct is to prosecute you want to see yourself as the impartial judge and it just isn't the case. You can't see these issue objectively. You can;t put aside your feelings and be impartial. And that means ultimately you can't trust your own judgment because it ISN'T judgment- it's just prejudice.




"You, on on the other hand, clearly just personally prefer that a clinic have no responsibility for patients after they scrape them out."

I fully agree with the parts of the guideline where they monitor the patient until vitals are back to normal and give them information on what to expect and what should be a warning sign. All of that is reasonable. But if a person has a bad infection they should not be back in the clinic. The clinic can do NOTHING for them.

I've had a couple minor surgeries. If a day later I started feeling bad do you think I'd go back to the clinic? Of course not. That'd be idiotic in the extreme. What are they going to do but call me a taxi? They can't treat a serious infection. They can't do major surgery. They can't house me overnight.

What is it you think the clinic could have done for Carolina? What is it you would have had them do? Pay one of their nurses to spend the night watching her? Maybe had her sleep on the stirrup table? done the bloodwork they don;t have facilities to do?

This is ridiculous. If you get new tires and afterward your transmission breaks you don't go back to the tire shop EVEN IF IT WAS THEIR FAULT. You go to the garage. Why? because the garage can treat a broken transmission and the tire shop can't. Now after you get out of the garage you might sue the tire company. That's fine. If they are negligent then hopefully you get a tidy settlement. But you can't expect the tire company to fix the problem because they just don;t have the tools and expertise!

I can't imagine why this is a hard concept to get across.

GrannyGrump said...

You choose to see every action, every motive, in the worst possible light.

Vanessa Preston:

"To the credit of Boyd and the Fairmount staff, emergency procedures were immediately instituted. An ambulance was summoned, and Boyd and a nurse performed CPR and got Vanessa's heart to beat again."

"Boyd, to his credit, reported Vanessa's death to the Centers for Disease Control. He also wrote a medical journal article about her death, warning other abortionists that DIC could occur during second-trimester evacuation abortions."

GrannyGrump said...

What the clinic was supposed to do was have their triage person (typically a nurse trained in abortion triage) assess her symptoms and instruct her what to do next. In Carolina's case, this might well have been, "Get to the nearest emergency room." But they didn't tell her anything because they didn't return her calls. This led to a delay in seeking treatment, allowing the infection to take hold.

How was Carolina, a layperson, to judge if her symptoms were severe enough to warrant a trip to the emergency room? She wasn't a nurse, she wasn't trained to make that sort of call. So she was put in a position of waiting until a it was clear even to a layman that a trip to the ER was in order.

The patient has no way of knowing what's normal, just the pain of recovering from surgery, versus something to be alarmed about. That's why the standard of care is for a 24-hour medical on-call staff person. So that somebody who has training in abortion aftercare is assessing these things.

Tlaloc said...

"But they didn't tell her anything because they didn't return her calls."

And as we already discussed it isn't clear whether she even spoke english, nor is it clear whether the clinic was open during the holidays. Again the very fact that she got an answering machine suggests she may have been calling when the clinic simply wasn't open.

The pretty obvious logical response is to then go to or call a medical facility that IS open. Like... er... a hospital?



"How was Carolina, a layperson, to judge if her symptoms were severe enough to warrant a trip to the emergency room?"

Gosh emergency rooms must be empty if lay people can't figure out when to go to them! You are stretching so far to try and make this their fault, Christina. People decide for themselves when they need to go to an emergency room every day. A person who has just had surgery and is experiencing strange symptoms shouldn't have a hard time figuring this out. Even without a medical degree. And if they choose not to bother going and getting help that doesn't magically become everyone (or anyone) else's fault.



"The patient has no way of knowing what's normal, just the pain of recovering from surgery, versus something to be alarmed about."

The clinic should certainly have told her what to expect. Biut you have no way of knowing if they did or not. Nor do you have any way of knowing if she understood what they said or not. But I'm guessing you'll assume they're in the wrong anyway.



"That's why the standard of care is for a 24-hour medical on-call staff person. So that somebody who has training in abortion aftercare is assessing these things."

Can you show that this was a standard in 1996 and that the clinic in question was required or voluntarliy agreed to operate under this standard (i.e. was it either the law or required by some agreement they entered into)? Cause if not then all you have is "Christina's rules that abortionists have to play by" which frankly I don't expect them to care about seeing as you are trying to drive them out of business and all.

GrannyGrump said...

And as we already discussed it isn't clear whether she even spoke english, nor is it clear whether the clinic was open during the holidays.

I've lived in a country where I don't speak the language. I've either sought out medical/dental providers who spoke English, or brought a Korean-speaker with me. I find it hard to imagine any medical facility catering to the poor in the Miami area not having Spanish-speaking staff, but even assuming that this place had no Spanish-speaking staff, they could have at least returned the call, could have at least had a little card staff could read that said, "If you have a medical problem, please go to your doctor or call 911." This is Miami we're talking about. It's not like the clinic was in Frog Knot, Arkansas, where nobody speaks Spanish.

That said, whether or not they were open over the holidays is irrelevant, because standard abortion care is to have a 24/7 hotline to handle aftercare.

GrannyGrump said...

The pretty obvious logical response is to then go to or call a medical facility that IS open. Like... er... a hospital?

Not if what you're calling for is to find out if your symptoms are cause for alarm or not. Again, the standard of care is a 24/7 hotline, where there is somebody trained in abortion triage.

Imagine for a moment that you're poor and uninsured. Are you going to go waltzing into an emergency room when you're not even sure if your symptoms are normal or not? Or are you going to think about the two children you're feeding and clothing and sheltering and keep trying to get hold of the people who are supposed to be manning a 24/7 triage line for you?

Tlaloc said...

"I've lived in a country where I don't speak the language. I've either sought out medical/dental providers who spoke English, or brought a Korean-speaker with me."

Oh but one of your big evil nasty points against the clinic is that they providered her with a consent form in english that she couldn;t read. You can't have it both ways. Either the clinic had the reources to communicate in spanis or Carolina in english, or they didn't. You can't simultaneously ding them in one case for saying they did and in another for saying they didn't.



"I find it hard to imagine any medical facility catering to the poor in the Miami area not having Spanish-speaking staff"

They probably had spanish speaking staff but they may not have had them available 24/7 to answer calls. See where this is going? Someone calls speaking rapid spanish, the person you have that speaks spanish on staff is off on vacation since it's the week of christmas. You have no idea what they've said you can't even make out the phone number or name. So what do you do?

There's not much you can do. Other than get vilified by the pro-lifers for apparently not being bilingual.



" but even assuming that this place had no Spanish-speaking staff, they could have at least returned the call,"

My phone number is funf funf funf sechs sieben ein drei.

What do you mean you can't call me back because you can't speak german! Get the point?



"That said, whether or not they were open over the holidays is irrelevant, because standard abortion care is to have a 24/7 hotline to handle aftercare."

Again standard? According to an agreement that hadn't been created yet? Can you show that this standard was either law or part of an agreement this particular clinic had signed on for?

GrannyGrump said...

Can you show that this was a standard in 1996 and that the clinic in question was required or voluntarliy agreed to operate under this standard (i.e. was it either the law or required by some agreement they entered into)?

Oddly enough, I don't have access to Florida's 1996 regulations for abortion clinics. Fancy that! What you're postulating is that in 1995, it was standard operating procedure for abortion clinics to shove them out the door with a pat on the back, and the very next year suddenly out of the clear blue sky a 24/7 hotline became the standard.

But I'll tell you what -- I posted the question to NAF's site:

I'm having an online discussion with somebody about standards of abortion care. I provided a link to your Clinical Guidelines as evidence that 24/7 phone service for emergency aftercare questions is the standard. The other person says that since your Clinical Guidelines were published in 1996, there is no evidence that any kind of aftercare was standard or expected prior to 1995.

When did a 24/7 aftercare hotline become the standard of care in abortion practice? Recommendations by NAF, PP, the CDC, the ACOG, or some other reputable body would be adequate evidence. Was it considered the standard of care in 1995?


Now, they may recognize my name and decide not to answer me. (I'm the one who did the "sting" for "Lime 5", after all.) But you can contact them.

Phone: 202-667-5881
Email: naf@prochoice.org
Hotline: 800-772-9100

GrannyGrump said...

People decide for themselves when they need to go to an emergency room every day.

Yes, but it's also fairly common to wait until symptoms are alarming -- especially for somebody who is currently under a doctor's care and still attempting to contact said doctor for advice. With a woman who is suffering abortion complications, symptoms that don't seem particularly alarming may need immediate care.

Tlaloc said...

"Not if what you're calling for is to find out if your symptoms are cause for alarm or not."

Of course it is! If you have a medical issue and you don;t know if it's a big deal or not you call your personal physician, an ask the nurse service, or the local hospital. Pretty much in that order.

Where do you get this idea that no one knows if they need medical care and no one calls a hospital to find out?



"Again, the standard of care is a 24/7 hotline, where there is somebody trained in abortion triage."

Again you'll have to support that with something more than your word and an anachronistic document.



"Imagine for a moment that you're poor and uninsured. Are you going to go waltzing into an emergency room when you're not even sure if your symptoms are normal or not?"

hell yes since you face no financial liability whatsoever. You can walk off the street into any emergency care demand treatment for any (real) emergency and walk out again and never pay a cent. They cannot deny you care. They cannot send the bill to collections. The only thing they can do is raise the rtes on everyone else.

Until we get universal health care that's probably for the best. The poor do deserve medical care too. And it is absolutely their fault if they choose not to get it when it is provided for FREE.



"Or are you going to think about the two children you're feeding and clothing and sheltering and keep trying to get hold of the people who are supposed to be manning a 24/7 triage line for you?"

I'd think the two dependent kids would be a good argument for going personally. But, hey, what do I know?

As for the triage line who in their right mind sits around waiting to be called back in a medical emergency? If you just had surgery you should know that you are recovering. Anything that's odd is something to worry about.

Now if the clinic failed to tell her what to expect then I do fault them for that. But you can't even establish that they did that wrong. You just don't know.

Tlaloc said...

"Oddly enough, I don't have access to Florida's 1996 regulations for abortion clinics. Fancy that!"

I'm asking that you back up your assertion. If you can't then I'm asking you stop asserting it. It's not my fault if you don't have the information to prove what you claim.



"What you're postulating is that in 1995, it was standard operating procedure for abortion clinics to shove them out the door with a pat on the back, and the very next year suddenly out of the clear blue sky a 24/7 hotline became the standard."

No I'm postulating something far more reasonable:
that the reason the NAF put such a rule down on paper is because it WASN'T practiced everywhere. Kind of makes sense, huh?

Why bother writing down a rule
that nobody ever violates, right?

We don't have many laws about obeying gravity. Don't really need them. Generally standards are put in place to, well, make them universal standards.

What you are postulating is that every clinic everywhere agreed that a 24 hour triage line was the right thing to do but the NAF decided they needed a new booklet to spell it out anyway.

How likely is that?



"Yes, but it's also fairly common to wait until symptoms are alarming -- especially for somebody who is currently under a doctor's care and still attempting to contact said doctor for advice. With a woman who is suffering abortion complications, symptoms that don't seem particularly alarming may need immediate care"

All of which is very true and none of which is the clinic's fault in the slightest. Yes people do dumb things every day. We eat unhealthy foods. We don't get exercise. We ignore warning signs of heart attack, ulcer, cancer, aids, whatever. And whose fault is that?

Ours. And ours alone.

GrannyGrump said...

Tlaloc, I'm finding it very difficult to imagine malpractice so heinous that you'd actually find fault with the clinic for it.

Tlaloc said...

"Tlaloc, I'm finding it very difficult to imagine malpractice so heinous that you'd actually find fault with the clinic for it."

It's easy if just has to be malpractice, rather than someone making up standards to have been violated after the fact.

I know you;ve heard these questions before but they just seem so pertinent:

Did the medical review board find the clinic to have been guilty of malpractice?

Did the court in the civil suit brought by her husband find the clinic guilty of malpractice?

If either did then I am perfectly happy to accept their decision (barring some significant evidence of bias on their part). But I can;t help but notice you have never once answered me in the three or four times I asked you about the civil case? I suspect that if the court ruled against the clinic you'd be happy to present that fact. So I can only assume they either ruled in favor of the clinic or that their ruling isn't known.

Why is it you refuse to accept this fact: I am very against malpractice, but malpractice isn't just things you don't *like.*

GrannyGrump said...

I don't know the outcome of the civil case. I no longer work in an environment where somebody's buying expensive court documents and putting them on my desk to read.

After reading several thousand of them, though, I think I have more of a clue about what constitutes malpractice than somebody who hasn't abstracted a single case.

Tlaloc said...

"After reading several thousand of them, though, I think I have more of a clue about what constitutes malpractice than somebody who hasn't abstracted a single case."

Which would be fine, except as we've already shown your judgment is too heavily prejudiced to be viewed as an impartial source of information. You want them to be guilty far too badly.

GrannyGrump said...

It's hard to read case after case of young women -- young girls, some of them -- traumatized, maimed, or dead for no good reason, and not start to get where you have a grudge against the people who hurt them.

Tlaloc said...

"It's hard to read case after case of young women -- young girls, some of them -- traumatized, maimed, or dead for no good reason, and not start to get where you have a grudge against the people who hurt them."

That's understandable, but then you are getting a skewed persepective. What you aren't doing is reading the hundreds of cases where a woman is extremely grateful for an abortion for every one horror story.

Come on Christina, you know that there are something like 4,000 abortions a day in this country. If even 1% of them went badly the prolife side would have been the *only* side a decade ago. The fact that after decades of legal abortion the prolife side is still the minority or at best just even with the prochoice side (and as before that counts an awful lot of people woh incorrectly call themselves "prolife") means that clearly abortion has not been going badly very often at all.

You read hundreds of bad cases out of the MILLIONS of total cases. But because you ONLY read the bad you get a skewed perception.

GrannyGrump said...

That's understandable, but then you are getting a skewed persepective. What you aren't doing is reading the hundreds of cases where a woman is extremely grateful for an abortion for every one horror story.

Well, we can set aside the fact that I'm not going to find a woman grateful for an abortion to be particularly sympathetic. Because that will get us into a slogfest over exactly what's destroyed in an abortion. I know you see valueless tissue of no more consequence than a hankie full of snot, and you know I see a baby. So let's set that aside.

Let's look at what I've been immersed in. The very first abortion deaths I learned of were Gloria Aponte and Ellen Williams. Hanan Rotem (who killed Gloria) was letting an untrained receptionist administer general anesthesia. Dadelanc (the mill where Ellen was killed) was so disgusting that one abortionist quit working there and said that he wouldn't bring a dog there. Ellen came to them with raging peritonitis; they gave her tea and a bottle of oral antibiotics and sent her home to die. How many happy customers would these guys have to have before you'd say, "Well, this excuses what they did to Gloria and Ellen"?

There's a young woman in New York who has been blind since she was 12 years old, because of fetal bone fragments that got into her bloodstream and lodged in her brain. She had to have a hysterectomy. At age 12. The people who did that to her successfully blocked the lawsuit filed on her behalf on the grounds that she turned out to be over 24 weeks pregnant, so technically her abortion was illegal, and in New York you can't sue for damages you suffer while you're participating in an illegal act. They were never prosecuted for this illegal abortion; they just used its illegality to weasel out of compensating the family for the expenses they were stuck with. How many happy customers would these guys have to have for you to say, "This offsets the damage they did to that girl."

I'm willing to grant that Curtis Boyd didn't intend Vanessa Preston any harm, that he ran a professional facility with adequately trained staff and that they did everything in their power to save her. I'm willing to grant that he meant well doing an abortion. I can't blame Curtis Boyd for Vanessa's death. But she's the exception.

Leaving seriously injured patients unattended, shoving them out the door to die, sticking an eviscerated woman into a taxicab... At what point does the "but he has many satisfied customers" kick in and make this sort of thing excusable?

GrannyGrump said...

Tlaloc, here's my answer from NAF:

It is difficult to answer your question about when the guideline for emergency care following an abortion was established. Medical standards for ambulatory care following surgery, has generally included follow up care, including 24/7 emergency referral systems. Whether or not abortion clinics were in compliance with this medical standard in 1995 is unknown, as NAF did not have a complete monitoring system in place until 1999. Standards of practice for ambulatory care may be the best evidence we have supporting the inclusion of this guideline in our Clinical Policy Guidelines.

Tlaloc said...

"Well, we can set aside the fact that I'm not going to find a woman grateful for an abortion to be particularly sympathetic. Because that will get us into a slogfest over exactly what's destroyed in an abortion."

No there's a more fundamental point here:
you care when women are unhappy but don't care when they are happy. At least if that happiness is because of abortion.

That mean fundamentally what the women feel is of no matter to you. you hate abortion regardless. If there was one unhappy woman you would use that ats the excuse for your hatred to deny all the ones who are satisfied because what they feel just doens't matter to you.

Do you understand that you just admitted that you don;t care about the women. they are a convenient excuse for you to use and nothing more. You discount them when they don;t support your point.

Think about that, Christina. All your claims about doing this for women are false. At some deep level you know that. This is and always has been about *YOU*. What you want, and what you think is right. Regardless of who that hurts.

Tlaloc said...

"Let's look at what I've been immersed in."

Look what you've CHOSEN to immerse yourself in.

Imagine a woman who has no contact with men and only reads about serial killers. Of course she'll hate men. She'll think they are all twisted psychopaths because that's THE ONLY INFORMATION SHE LETS THROUGH HER FILTER!

Of course you hate abortion clinics you only let the negative info through and then you wallow in it refusing to hear the other side and pretending the bad stuff is all that is when the bad stuff is only the tiniest fraction of what is.

The few hundred or even a thousand cases that are bad are simply buried under the tens of millions of cases that go well.

Tlaloc said...

"Leaving seriously injured patients unattended, shoving them out the door to die, sticking an eviscerated woman into a taxicab... At what point does the "but he has many satisfied customers" kick in and make this sort of thing excusable?"

The probelm is that you aren't condeming a single bad doctor. You try to condemn the entire field.

There is no excuse for a doctor who is malfeasant. By all means rail away. But don't pretend that that bad doc is more than .01% of all the doctors doing abortion. Don't pretendd that his actions reflect on abortion in total.

A bad doctor is a bad doctor. A bad brain surgeon doesn't make neurosurgery wrong. A bad abortionist doesn't make abortion wrong.

GrannyGrump said...

But don't pretend that that bad doc is more than .01% of all the doctors doing abortion.

Where do you get that number from? Do you even know how many abortionists there are, and what percent of them have been disciplined or sued for quackery?

GrannyGrump said...

Tlaloc, I cut Curtis Boyd slack because he seemed to mean well. And I think Warren Hern, Suzanne Poppema, David Grimes, and Michael Burnhill mean well. (Or meant well, in Burnhill's case, since he's pushing up daisies now.) I don't universally dismiss them as quacks.

But when even the Feminist Women's Health Center noted that nearly 90 percent of abortionists at freestanding clinics are on probation with the medical board, I'd have to say that it's not just my perception that these guys are prone to quackery.

GrannyGrump said...

Yes, I hate abortion regardless of whether or not the woman is happy about it, just as I hate any other instance of Person A having Person B put to death for reasons of Person A's preference.

Let's turn this around, shall we? You think that Ashli is totally an unsympathetic character. You want her to bite down, shut up, and be grateful that her baby's dead. Does that mean you wish Ashli ill, just because you find her unsympathetic? Just because her anguish only annoys you?

Tlaloc said...

"Where do you get that number from? Do you even know how many abortionists there are, and what percent of them have been disciplined or sued for quackery?"

It was hyperbole, not a serious number.

But since you raise the issue, just how many abortion doctors have been jailed or had their licenses revoked since legalization?



"But when even the Feminist Women's Health Center noted that nearly 90 percent of abortionists at freestanding clinics are on probation with the medical board, I'd have to say that it's not just my perception that these guys are prone to quackery."

I need to see some support for that number becuase I find it pretty ludicrous.



"Yes, I hate abortion regardless of whether or not the woman is happy about it,"

So from now on you no longer hget to argue that you want what is best for women. PERIOD. You don't. You want what is best for you, and if that happens to be okay for them then you're happy but if not you. just. don't. care.



"You want her to bite down, shut up, and be grateful that her baby's dead."

No that's not true at all. I understand entirely why she was upset at losing that pregnancy. What I said though is that she is wallowing in her feelings by prolonging it TEN YEARS rather than moving on. She suffered a loss, surely, but you either deal with it and move on or you take on the role of eternal vitim. She chose the latter. And no I don;t repsect that.



"Does that mean you wish Ashli ill, just because you find her unsympathetic? Just because her anguish only annoys you?"

Again it isn;t her anguish but her CHOICE to just stay in that space. To portray herself as a victim and to castigate the very people who saved her life and her sanity. She had a bad situation but she is the only one who has decided not to let it go.