Saturday, November 27, 2010

pipe dreams

This Thanksgiving I found myself telling my mother-in-law a snippet of a story my siblings and I all know, but I don't believe I've ever repeated. Here's how it goes. I think that my mother ended every Thanksgiving of my childhood with her head on the kitchen table sobbing after she sent my brother and sister and me to our rooms. I don't literally remember witnessing this every year, but every year I would have been able to witness the whole scene, I did. And she certainly bellowed us into our rooms every year well before the end of dinner.

At the time, I had very little idea why. I didn't really feel sorry for her (I know that's awful); I thought her crying was horrifying, but that's about it. Of course, this has its roots in how much we hated my mother, which, in turn, is rooted in both my parents' use of their divorce (when I was six) as an opportunity to use their three children for rhetorical points: my mother's theme was that divorce is evil (I don't disagree, but that was not the forum in which to make that point), and my father's theme was that my mother was crazy and he had no choice (true and false, respectively).

As I've mentioned before, my mother is mentally ill. As near as I can figure, the great annual Thanksgiving disaster worked a little something like this. She grew up in a big Irish family, the second-youngest of seven. Her mother was the matriarch's matriarch - neurotic housekeeper, prolific cook, demonic disciplinarian, mistress of her domain. (Her children were not allowed to enter the kitchen without express permission - on any day, ever.) Of course they had a huge traditional American Thanksgiving dinner. My father's family thought Thanksgiving was stupid, but after my father left (and maybe before? I don't remember) my mother tried to institute the tradition.

We often didn't have enough money for basic food (I remember her trying to economize by buying powdered milk, which we wouldn't drink), but she'd really work hard to do special occasions right. The turkey was never even moderately sized - it was always huge, even just for one adult and three little kids. She didn't do sweet potato casserole or anything distressingly modern, but there were mashed potatoes, gravy, stuffing, cranberry sauce - all made from scratch (though I think she eventually switched to canned cranberry sauce). Hours and hours of work, all while trying to keep us from burning the house down. All by herself.

Because, apparently, Thanksgiving dinner had to be picture-perfect, for her totally imperfect family. The problem was, none of the three of us gave a hoot about Thanksgiving. We didn't have warm memories of Thanksgivings past (see above), had no other family visiting in whom we were interested, and were rebellious and difficult every day of the year. After just a few comments about how dark meat was gross or we hated gravy (we all hated gravy. I guess she liked gravy, but it seemed like a waste of effort), and a few instances of us playing with our food and yelling at each other and chewing with our mouths open and talking back, we were all sent upstairs, forbidden to have the made-from-scratch pies she had also slaved over. Another miscalculation: only one of us even liked pumpkin pie, and nobody was passionate about it. So, eager to withstand a punishment bravely, we told her that we didn't care. We marched upstairs and commenced hooting and hollering at each other, and she looked around at eight hours of wasted work (just like last year), and four hours of cleaning still to be done (without help, and without even a dishwasher), and broke down.

And...scene.

Obviously, the woman should have gotten a bunch of turkey subs at Subway and called it a holiday. But she never did; she trotted out the pointless, doomed melodrama with the turkey every year. By the way, her turkey was always perfect. Perfect. Like on the commercials. I can't roast a turkey (or even a chicken) correctly, and I'm a decent cook, in general. But she never missed.

She did the same thing with Christmas, except that for Christmas, the focus wasn't the meal. The drama there was ramped up by the fact that my father's family tradition is to celebrate on Christmas Eve. So we'd do the Polish vigil dinner with him on the 24th, and then presents, and then midnight Mass (which ends well after 2AM), and sometimes he'd be too tired to drive us to her house from the city (and get home at 4AM). So often we'd get there the next morning, and kids never get underway efficiently, so it would never be early, and she'd already be furious.

He also always (somehow) had more money to spend on presents. Of course, she spent untold hours making whatever gifts she could afford look absolutely magnificent. No one can wrap a package like my mother. She bought all her paper (in her signature Swiss dot print) for about nine cents on sale in January, but it looked like a Tiffany's window every year. She might have used computer-aided drafting to get the stacks of gifts perfect. And then there was the heirloom creche that we broke several pieces of (never on purpose, but they were ceramic, and we were kids). I doubt we ever said a nice word to her about how incredible a job she did - but then, we never saw it with joy and wonderment. We saw it after 45 minutes' anticipation in the car of how angry she was going to be (and my father never calmed her down so that we and she would have a more peaceful morning - heavens, no), and then her screaming and my father leaving, and her threatening not to let us have our presents at all (so we would typically say, "we don't care"). Then when we opened the presents, we knew they were going to be underpants, and strange aspirational gifts intended to mold us into different people (cookbooks for my brother, for example). Of course she had to buy what was on sale, but she never had any idea what any of us wanted for Christmas, or even what we liked, and she never inquired. So the presents were always weird.

In other words: my mother obviously did not get the life she wanted, or even a remotely fair one. Being poor was one thing, but being poor and mentally ill and having your husband walk out on you and take up with one of his students and turn your three kids against you - well, that's a bit much for anyone to take, and she wasn't all that resilient to start with. But she never adjusted to the circumstances she had. In later years, she made concessions (she decided we would celebrate Epiphany with her instead of Christmas, for example). She never stopped expecting that the holidays would look like an L.L.Bean catalog, though. And it was absolutely out of the question that that would happen. She was setting herself up for failure before she bought the first potato or spool of ribbon.

Presently my goal for my holidays is to have enough family around to feel like there's a point making food, and for the members of my insane family not to be so insane that they really offend or hurt one another or anybody else. (Frankly, I need to have perfect strangers at the table to act as a buffer.)

But the holiday picture I try not to think about, the one always there in the back of my mind that's breaking my heart, is of a big house (not too expensive) with a giant fire in the fireplace, pine garland everywhere, stockings hung on the mantle, a ridiculously tall tree hung in hand-me-down ornaments, snow on the ground outside, a table full of food, the whole family gathered around (an act of Congress would not make this possible - but some year, I want not to have to make apologies to anyone for missing them. I have been angering someone with my absence at Christmas since I was seven years old, maybe six, and I am tired of it). And, of course, on Christmas morning (or maybe after Wigilia dinner), a parade of small children in red pyjamas with messy hair running to open their presents, labeled, as my mother's always were, "from Santa Claus."

It won't happen, and the cynicism has settled down deep enough that I really don't expect it any more. But I still know that it's supposed to; I still know that my in-laws wish they could be nearer their grandchildren (my SIL's five beautiful children), and would be very happy with a set here on the East Coast to visit for when they can't get to the Southwest to see the others. I still know that we could credibly invite everyone to visit us, if we had little ones here, instead of being the best situated to buy plane tickets. I still know that the animosity and division created by my parents (and others in my family) over the holidays are supposed to be healed in my generation, and that's exactly what we would be doing, if we had a next generation to structure this around. But we don't.

But I don't get to dwell on that. Unless I want to join my mother in the "mentally ill" club, I'm going to have to work with the family I have. I just wish I knew how.

Tuesday, November 23, 2010

Braver with Pants On

So I went to my appointment yesterday. I was good and introduced myself to the practice administrator guy before I went in. That was fine. I brought copies of my charts since my last appointment (May), carefully marked with my all-new premenstrual spotting, as well as the intermittent ovarian pain. (I discovered when marking it that it generally appears somewhere around CD7-10, generally lasts about three days, and remains through the first day of fertile CM, then leaves.)

Dr. L/C was focused on getting me a new prescription to stimulate ovulation, but I managed to drag the focus back to doing something about the ovarian pain, which I believe to be cysts. She did an exam and said that there was no indication of cysts, and also noted that the pain doesn't appear in my cycle where an endometrioma would cause pain. (I already knew that, but darn it, it feels like cysts to me.) She didn't have any specific ideas - possibly scar tissue around the ovaries that tightens leading up to ovulation, she said, but she wasn't sure.

So, the plan is that I will get an ultrasound right before ovulation and see whether the culprit can be spotted. If it is something cyst-related, we can make a treatment decision then. She didn't think depo would be all that helpful (lupron and the like shrink adhesions, but endometriomas are more serious and she would not expect them to comply). If there's nothing wrong with me (you know, other than me being in pain), then I have various treatment options...she proposed tamoxifen, clomid, or femara (oh joy! Apparently, femara is now an option without a fight).

I also asked about HCG shots, and she said this supports good hormone levels post-ovulation, rather than a strong ovulation. She seems more concerned with the latter (I mean, fair enough, since I'm not pregnant). Because of the premenstrual spotting, it seems to me that the only thing obviously in need of remedy is my post-peak progesterone level. So maybe I will lobby for femara and HCG, or something. But only after seeking out the cysts (I still believe they're cysts) and doing post-peak bloodwork to check on the hormone levels.

My husband is very relieved to hear that the doctor does not think I have cysts. While I cannot argue with the reasonableness of this response, I disagree completely. I have had lots of cysts. If the prognosis is that surgery could (temporarily) fix the problem and something else might perhaps help in the meantime, and the problem is a serious impediment to fertility (but hardly the only one), that doesn't seem so bad to me. If the prognosis is that surgery probably will not help the problem and would not in any case be advisable, and that no medication (including analgesics) will do anything whatsoever to limit it, and I will be in pain for years (but there's no impairment to my reproductive health) - then I'm not happy. At all.

I guess this means I'm not just kidding myself when I say that I no longer hold out hope for a child, and just don't want to live the rest of my life in pain. I know there are people with much worse problems, but that seems like so little to ask.

Oh, and I didn't actually discuss my historic problems with Dr. Lorna. She appeared in a massive rush from her last appointment (mine was late because some pre-op patient decided to show up three hours late and the nurses had committed to seeing her "whenever she could make it," which I don't hold against the doctor). And she didn't seem hostile. And she offered the femara,* which is what I had originally wanted. Some people like to hash things out, some don't...some (like my crazy family) prefer to make nice by making up for problems rather than talking about them.

For now, I am going to accept that that's where we are and proceed with the next round of diagnostics. And, at the same time, I need to be looking into other options. At some point, I will gather my courage to make the requisite phone calls.

*For some peculiar reason, I initially wrote "tamoxifen" here. As I have documented thoroughly elsewhere, I DO NOT LIKE TAMOXIFEN.

Sunday, November 21, 2010

the week loometh

I continue to nest in my mind. Today I spent just a wee little bit of time in a thrift store and somehow still came home with an Asian-themed folding screen (due to the stupendous bargaining efforts of an IF friend, I got it for $35! All I seem to do with other infertile gals is eat chocolate and shop. It's a good life, really) and a really pretty ivory jacquard flat sheet that goes with my duvet.

We went to see the house in our neighborhood and the things the former owners did to it are bewildering and shocking. I'm not entirely bewildered that they decided to finish a cellar-type basement with serious dampness problems; that's just an extreme form of run-of-the-mill stupidity. But the resulting mold down there was really scary, and between the probably high cost to buy it, the high cost to fix the innumerable problems, and the fact that it would not be safe to inhabit for the first couple of months...just more than we can take on. So, it's out. The pretty Victorian that was similarly too much money we did not visit (someone who shall remain nameless was more attached to watching his football team play during the open house hours). The too-small house is...still too small.

My over-nurturing has found another target, however. I discovered a house which, on all the objective information, is a "middle ground" house - bigger than the too-small, smaller than the too-big; not over-finished, so it shouldn't be too expensive. Problem is, the owners refi'd it to the hilt and are (after a price reduction!) asking $220,000 more than the tax assessment (and $150,000 more than the highest independent assessment). It would be admirably suited to us if it were selling at market value, but how to make that happen? My realtor says we should go see it, and I'd be OK with that. Maybe I can pass the owners a note that says, "Talk to your bank about maybe doing a short sale! Love, the misfit (future owner of your home)."

Oh, and my DH and I have decided to spend Christmas here rather than traveling to see family (we will see some at Thanksgiving and visit others early next year). I'm touched that that's what he wants to do; that he has a special place in his heart for Christmas with us. (My sister will be with us too, I think, and my brother has been invited but probably will not come). And I'm excited about that - I love doing the holiday cooking and I love the idea of being responsible to find a tree and decorate everything and make sure home is ready for Christmas. Plus the traveling can all be so exhausting.

Of course, this causes me to daydream manically about closing on a house and moving before Christmas. That will never happen, so I shall have to pry myself free mentally from those images so I can focus my energies on getting the Christmas shopping (and packing and shipping) underway, cleaning the house, and taking stock of the decoration situation.

Daydreams I am not entertaining include celebrating a BFP at Christmas. I will have to make do with the babe in the manger.

Tomorrow I will be teleworking (somehow the opportunity to put in a productive day's work from a fluffy blanket on my beloved couch with a mug of whipped-cream covered chai always makes me feel better) so that I can head to my appointment at Tepeyac during the middle of the day. I've printed out my charts in color, and I still need to mark "ovarian pain" in the appropriate places to explain why I'm sure the cysts are back.

I talked to my DH about dealing with me if I take depo, and I think we will be able to make it work. (Hormone drugs make me psycho, and he generally reacts to that by trying to teach me a good lesson. I have explained to him that I will still have an obligation to be reasonable, but that can't happen until I calm down and the problem is that I have a very hard time being calm when I'm on this stuff - so he needs to calm me down first and then address the problem. I think this could work.)

Of course, I also need to talk to Dr. L/C about continuing with Tep.eyac. Right now my inclination is that I will not continue with them much longer. Finding another situation that would work well has not been easy thus far (though I have the number of a friend's doctor whom I should call). But since I have not spoken with her in person since all the nonsense happened, I would like to do that first.

I talked with the practice administrator there last week. He is very very nice (although, honestly, sometimes I wish Catholic professionals would not mention God at all but be ruthlessly competent. Wouldn't God be glorified by that so much more? It would at least make my life better). He said that the communication issues should never have happened and he was really sorry. Apparently there was a lot of Dr. L/C being out at the hospital on the day I would call, and then messages getting shuffled around and lost. And apparently she said that she had responded to my email earlier and it went to the wrong address (but no one has seen any evidence of this, I guess. It could be true, but it doesn't explain why she didn't re-send it when I kept calling).

He said that the practice as a whole is working on a general problem getting in touch with doctors who are on days at the hospital, since the GYN doctors never respond to each other's patients (but the OBs do). While I sort of understand why this distinction would exist, given that that's how OBs practice generally (i.e., when you go into labor, my understanding is that you get the on-duty OB, whether it's your doctor or not), it's just another way in which it's extra, and unjustifiably, hard to be an infertility patient.

Although I was frustrated that it took so long for me to talk to someone at Tep.eyac about all of these problems, I realized that it's a good thing I ended up waiting so long. I was much calmer when I talked to him, and I was able to listen to what he had to say and make my points with a minimum of emotion. But I said some things I'm very glad I got a chance to say, and I felt as though I was not only telling them things they needed to know about how to serve their patients, but saying things that infertility patients everywhere should get to tell their doctors.

I said that I understand why panicky pregnant women get calls back immediately and panicky infertile women who have to have a dosage clarified TODAY or they will have to wait an entire month before starting a new medication - might get a call back in several days. I understand it -but it's not fair that, in addition to being second-class citizens in society in general, when we go to get treatment so we can join all the lucky mommies, we're second-class citizens to our fertility doctors too.

I said that no one who has not been here could understand how hard it is to be in treatment for infertility, and that just making an appointment and facing another round of testing or treatment can be emotionally exhausting. I often avoid making the phone calls for weeks. If I have to make five phone calls to accomplish one thing, my life becomes unmanageable.

I said that I often feel that my doctor has no idea who I am, has not read some of my charts ever, and does not remember whether I've had the surgery - that she performed. I forget the details of my clients' histories too, but it's only right to brush up before the appointment.

And I also said that I think the practice would be well-served by using email as the primary method for asking routine questions of the doctor. Their official method (patient leaves voicemail, nurse plays voicemail, nurse writes voicemail down, nurse reads notes to doctor, doctor gives answer to nurse, nurse writes answer down, nurse calls patient and reads answer, patient asks clarification question, nurse begins process again) is extremely ineffective and frustrating. If patients could send emails to their doctors, everything would work better. He didn't promise to adopt such a policy, but I hope I've planted a seed.

Finally, he said that they're in the midst of a review and improvement of their office communication policy. And, when I said that I didn't really care whether Dr. L/C cares about my treatment, as long as someone will tell me if she doesn't so I can find another doctor (believe it or not, I wasn't snotty at all. I wanted to him to understand that this is actually the bottom line for me), he said that he can't tell me what doctor to see, but he would like me to give them another chance.

I don't feel that that obliges me to stick with them if I don't think it's advisable (and right now, I don't), but I was surprised to realize that it actually made me feel better to hear that. My impression has long been that people who have to deal with infertile women, in their capacity as infertile women, think that we are worse than worthless, and deserving of every kind of disdain and inconsiderateness. That he would even think that they'd want to keep me as a patient is almost shocking.

So that was that conversation. And tomorrow, treatment...as always, I am sort of emotionally bracing myself because it's so draining, but I'm as prepared as anybody in this state could be. And that...is the week ahead. Oh - plus Thanksgiving :).

Friday, November 19, 2010

holiday nesting

You know how I was being so good about taking my progesterone and I was celebrating not spotting? Right after I wrote that, I forgot to use the progesterone cream that night. No problem; I put it on the next morning (and then also used some the next night. So I got the same amount, and once was about nine hours late). But the day after I forgot it...I started spotting. (On p+8.) And have continued.

I tell myself that this was going to happen either way, and that while I probably delayed the spotting with the progesterone cream, I was never going to prevent it altogether. One late application wouldn't make that big of a difference. And if getting back up to speed hasn't made the spotting stop, then it was definitely coming either way.

Of course, the other side of this is that, since (thanks to the spotting) I start having symptoms of my next period as much as a week in advance, it shortens my available period of denial (AKA the 2ww). Or, alternatively, it just makes that denial much more severe. I.e., I know perfectly well what this means; but I come up with all sorts of secret theories about why this isn't inconsistent with a BFP this month, even though the same symptom didn't lead to pregnancy for the last several months. Infertility: a nuanced study in mental illness.

Also, even though he is no longer traveling internationally or for long periods of time, my DH is scheduled to miss my entire "fertile" phase in the upcoming cycle (the one that I was going to time perfectly after I figured things out with this cycle - this cycle that's already a bust, that is). I am pissed. I haven't told him yet. I probably have to find a way to do so with less hostility.

Finally, the spotting also means one other thing: I am PMSing. For me, this means an intensification of all my negative emotions, the suspension of my ability to be reasonable if I don't feel inclined to, and the amplification of any kind of emotionally immature fixations to the point that they drown out all other aspects of my personality.

It's November. It's almost Thanksgiving. In the last week or so, it finally got cold-ish. My yard is covered in leaves (no, I am not contemplating raking just now. Life is difficult enough). I have already made pie this fall (three apple pies, to be exact). I am wearing boots on a daily basis. Today is casual Friday, so I have wrapped myself in cozy layers of wool. I can make some defense that the outfit is stylish, but I'm basically wearing blankets and sitting in my office chair. All I need is some cocoa. (Actually, I really do need some cocoa. Note to self: carefully schedule afternoon...)

All of this adds up to one inevitable conclusion. I want a house, and I want one now. A big house - OK, not unnecessarily huge (though some of the things on the market now do fall into that category). I always think of the beautiful Chicago home (er, mansion) in the first Home Alone movie. That was a house. And a house at Christmas - as all houses should always be. I don't want one that large or that expensive (there's only two of us). But something with that sort of feel. So though there are no really promising options out there just now (well, none that haven't been vetoed by my husband), I am madly going over and over the rejected options to find one with potential.

There's a handsome house in my neighborhood that's in foreclosure, which my DH loves. It's priced above what we'd be willing to pay, and I know there are other offers on it, so getting it for the price we want might well be impossible. Two other problems: (1) I have never seen the inside. It could cost more to repair than we could afford. And, it was built in 1938. While it's got an older look, given my preference for Victorian-era architecture, I may just be unable to love it...I'll have to see. (2) It's right in my neighborhood. While this is a nice place to live, part of me really wants to move somewhere else - near to a parish with a real community, and, frankly, a little farther away from all our friends who have kids or are about to have them. I need a polite reason to put down roots in a new community and not spend all my time visiting them and their kids. I think a new town would give us a fresh start.

There's a really adorable house in the area I'd prefer. It's in a plenty nice neighborhood, it's adorable, it's in good shape, it's a really good price, it's got a lovely yard, it's commutable, and it's near a church that is acceptable. But it's so little...we've been thinking that since we're grown-ups some day we should have a queen bed. This house has three bedrooms, and none would fit a queen (they're all miniscule, and we can't combine two - there would only be two left!). Only one room even has a closet. The full bath also has a mini (not even standard-sized) tub, and no room to expand to fit a bigger one. We'd like a decent-sized bathtub. Is that so much to ask in a home we own? And it has no room for a dining room or a study. I keep trying to convince myself that it's perfect, but I just don't think it would work.

And...there's a giant (way, way more space than we need) gorgeous Victorian-style home as well. It costs too much (same as the one in our neighborhood, actually). And it would be a pretty inconvenient commute. Some of the decor is really weird and should be changed, but it's in good condition.

At another time, I would reject all of these options. But I cannot bring myself to let go right now. I must nurture whatever possibilities exist. I want to throw a (formal-dress) New Year's Eve party this year, and my rental house is not big enough to swing it, so I am at the mercy of others; others who are wonderful people, but will not understand that New Year's is a formal occasion. And I think we may be staying home for Christmas (and inviting some of the family to join us if they wish), and I could do wonders with a house with multiple bedrooms. And a dining room.

It's Christmas. I need my own house. More expensive than the tiny house would be fine. Less expensive than the other two is necessary (and smaller would be just fine). I don't mind if it has an insane kitchen and ludicrous decor and things falling off as long as, underneath, there are wood floors and real fireplaces and antique casements and working radiators and strange useless nooks and crannies. Why doesn't the real estate market understand this???

Wednesday, November 17, 2010

all things...not necessarily either wise or wonderful

...or even connected to one another.

I spoke with the couple who lost the twins. It was more complicated than I thought. Since so many of you have been praying, I ought to provide an update. She was carrying fraternal twins. At nine weeks she started bleeding - from the wall of the uterus, the doctors thought. She was put on bed rest. At eighteen weeks, her water broke - only one amniotic sac. (I believe that child died in short order.) The doctors had a conundrum: maintain the status quo and risk that the dead baby (sans amniotic sac) would cause sepsis in the other baby or his mother; or deliver the dead baby, with the consequence that the live baby would also be delivered, before the point of viability. Because the mother has a history of staph infection, they chose the latter. Both babies were delivered (no anesthesia, ordinary delivery), and both babies died. They are burying them at Christmas.

Because the doctor induced labor before the point of viability (I think the measure was actually "before 21 weeks"), the requisite medical billing code is one that references "abortion." It is not the code for an ELECTIVE abortion - that's a different code. But the insurer (Ci.gna) does not cover abortion, they say, and so they refuse to pay it. I'm pretty sure their health plan is not a sea of billing codes...like mine, I bet it talks about the types of procedures covered. The health plan is the contract between the individual and the insurer, and is what gives the insurer an obligation to pay claims. The codes are just an administrative method for fulfilling the obligation. They are not binding (though the insurance companies try to pretend that they are).

I tried explaining this, but I don't think they were really looking for legal information. They've got the matter on appeal, and the doctor's office is really fighting for them, and they are planning to sue if the insurance company denies the ($11,000) claim after appeal. That's probably the right move, under the circumstances. It may be rotten in particular cases, but insurance companies are perfectly justified in denying claims for services their plans say they don't cover. But for services they do agree to cover - well, that's something else again. Sometimes (VERY RARELY, but this is the sort of thing the legal system is actually good for), a nice lawsuit helps to straighten things out.

In more mundane matters...I talked with Father again on Friday. I explained to him, among other things, how I get upset with bloggers who "cross over" to the pregnant or adoptive camp and say things that I (and sometimes only I) think are insensitive; and especially upset with people I know in real life, who say things I think are rotten. (I am so convinced that I try to be supportive of other people's decisions, or at least, if I can't be, to say nothing, that I get very upset when people don't do that with me. But I bet if I could see my behavior through others' eyes, I would be enlightened as to just how supportive I really am.)

And I told him about an argument I had with my husband. We spend a lot of time with two other married couples. Of this group of six, five (including my husband) went to the same undergrad. I didn't. I try, on occasion, to persuade the group to incorporate new members (such as a newly engaged couple we know), because, for one thing, insularity is annoying, and for another, I have no motivation to insulate myself in with a bunch of undergrad groupies who aren't from my undergrad. And for yet another thing - as I pointed out to my husband - one of the couples is presumptively normally fertile (and I am fairly certain they have just recently gotten pregnant and are lying about it to the rest of us. That would even be a brilliant move on their part, except that infertiles always know. Nice try, guys). The other couple has started the adoption process. In one year, both couples will have young children. Guess who won't?

Oh, that's right, the moron couple that is spending the overwhelming majority of its social time with people who, in one year, will have no time for us. Why would I do that to myself? I already feel isolated. Why make myself socially dependent on people who will soon be able to talk to me only around feedings? Or if I want to accompany them to the park (I don't)? Worse, the infertile couple is in the "I still like other people's children" camp. I realize that's a really good thing for them, but I am not there, don't want to be there, and am not going to get there (I probably used to be there, when I still had hope. HOPE IS A LIE). Ergo, inevitably, both couples are going to have about one week's worth of understanding about how very little I want to see them with their kids (very, very little. Not zero, but close to that). After that, they will expect me to want to see the kids all the time. When I don't, they'll avoid me (because I'm an evil weirdo baby-hating freak), and then I'll need to make new friends - with people I have neglected while my husband devotes all our social time to people who are diligently pursuing babies that I am not going to have.

(At this point I will let you know that if you feel any inclination to respond, "Well, why don't you just adopt, too, instead of making yourself an outsider? Then you could come to play group with them, and go stroller-shopping together!" you are no longer welcome to read this blog, and also, you should probably schedule time to see a competent mental health professional, because you need it even more than I do.)

This is probably a good time to announce what I have decided is my greatest pet peeve (today) about infertility. It's nice and lovely and also convenient if you're infertile and still enjoy other people's children. What it isn't is typical. It's nice to be exceptional (unless by "exceptional" you mean "infertile," of course), but it doesn't make you a morally better human being. I mean, maybe it does if you're grinning through the tears, but then your use of "enjoy" is questionable and also I think you're a masochist.

See, I am nice to other people's children sometimes, too. Yesterday I held a two-month-old because I couldn't come up with a convenient reason not to. (That's right, I'm supposed to say that I've been exposed to someone with a cold - always true, this time of year - and couldn't risk getting her sick.) But I don't like it. And there's no law that says I have to. What I enjoy and what I think is absolute torture is not a matter of good behavior. Being nice when I feel like setting mother and baby on fire is good behavior, but feeling like setting mother and baby on fire is just how I feel - not morally shaded at all. (Not that I think nurturing those thoughts would be morally sound.)

For people to act as if some virtue inheres in wanting to hold the baby, or to conjure up masks of horror if I mention in strong terms that I want nothing to do with the baby - is tiresome. Get acquainted with the rest of this demographic. Thank God for the blessing that you don't carry that particular splinter of the infertile cross. Take stock of the dysfunctional infertile behaviors that you do have (some of which, possibly, I don't). Realize that it's a mixed bag, and you don't need your cross to be made any heavier, and that it's really, really tiresome to have someone who should actually know better pull a holier-than-thou on you because you're going through hell and have the audacity to call it what it is instead of managing a socially acceptable, "Oh, I love babies...that's why I'd really like to have one."

I generally don't approve of strong language, but INFERTILITY IS SHIT. CALL IT WHAT THE HELL IT IS.

OK, I feel better now. Anyway, I didn't say all of that to Father, precisely. But the part about the diversifying our friend time I did. He said that it was healthy to spend social time with different people. But he also said that I was pushing people away because I didn't want to give them a chance to hurt me, and that loving people meant being vulnerable enough to let them hurt you. And I should consider that.

Now, he has some points. And in the abstract I concede that he is right. But in practice, that sounds like pretty dangerous advice. First of all, these are my husband's friends of ten or fifteen years - not mine. Before 2.5 years ago, I'd met one of them - once. If any of them needed my help (other than to babysit), I'd be right there, but love? That's a pretty strong word. Second, this is not a matter of whether they'll betray me. This is a matter of which month in 2011 is going to be the lucky month. And, whether you believe me or not, this is not a matter of a self-fulfilling prophecy. Who do I know who has kids and prioritizes my friendship over those kids? Seriously now. (Not that they should; the kids need them more. But it means my friendship is now marginalized, and that in itself is a betrayal, if I need that person.) What about finding time for me that's not interrupted by kids? Won't happen. What about getting through an hour in my company without bringing up the kids? Don't think it's ever happened. Will never happen. Regardless of what kind of week I've had.

Oh, and I can't tell them what kind of week I've had - because if I say something that would make them uncomfortable (not pained or suffering, not like me; just awkward) in the event they do talk about their kids, then I am a Bad Person. I would find this deal almost effortless if it came from someone else. If a girlfriend told me, "I just got dumped by a guy I thought was the one, and it's everything I can do not to cry my eyes out right in this restaurant, and I think your husband's a great guy, but I just cannot hear about one happy marriage right now, OK?" I think I could make that work. In fact, I would be touched that she had been that honest with me. I'm not less of a wife if I don't talk about my DH for an hour. And there's so much else to talk about if I want to.

But can you imagine an infertile woman trotting out that line? I think the earth would spin backward on its axis. The sky would turn an angry yellow and implode toward the earth, and the seas would rise up from their beds to engulf the land, and the voice of an angry God would thunder down from above, "YOU ARE A BAD FRIEND." Because if you're infertile, it's not your loved ones' job to make your cross lighter for you. It's your job to make your cross lighter...for them.

(I guess I wasn't quite done ranting.)

Anyway, I think Father is wrong, because they are going to betray me, and I don't do this "vulnerable" thing any more because even when I do it by accident, it makes the betrayals really, really ugly. Like where I contemplate homicide ugly. Because this world I live in is very ugly and cold already. You do additional violence to its wretched inhabitants, and I want blood. And how does Father know what kind of emotional resources I have to deal with needing someone, who will then turn around and make my life more miserable and wretched, rather than buoying it up? Not a lot, I can tell you. Part of the problem is that fertiles can't win. But for me, the problem is that almost nobody tries - and nobody tries hard. And if I expected that person to "love" me (I'll use his word) and care about my life and my broken heart, and she doesn't even try, because it's so much easier to open the mouth and let the stream of consciousness on the difficulties of potty training roll out, and not make eye contact with me, because she seriously knows better - but still can't be bothered to make the effort? Blood.

On from this, to the truly mundane...look at my chart for this month! First, dumb FF acknowledges that I ovulated this time. Ha. And that it can even be pinpointed to a specific day. Ha. And realizes that it's the same day that I know was peak day. HA! Unfortunately, I didn't realize that it was peak day until afterward (I was focusing on the "E" days, which are so much more dramatic, and had to re-read TCOYF before I realized that the "W" days deserved more attention), so I'm not sure how good our timing really was this month. The rational (but living in the past) part of my brain is reciting the fact that sperm live for up to five days in fertile CM, and the cynical (but up-to-date) part of my brain is noting sardonically that clearly, I should always assume the best-case scenario applies to me, in light of past experience.

Nevertheless, this might be my best cycle ever (so far, so far - I could pass an ovary tomorrow. Do not underestimate my reproductive system). Also, since peak day was obvious as soon as I hit p+1, I started the progesterone cream on p+1. And no spotting yet! Granted, I'm only p+7, but I'd been having 3-5 days of pre-menstrual spotting, and last cycle I think I had 9, so I'm calling this an achievement. Anyway, I am pleased with myself. In another week, I will be decidedly displeased, but weeks...can be like that.

Also also. You know, this post is too long. So, a teaser: I have an appointment with Dr. L/C on Monday, because I need a prescription or three to set up my next few months of treatment (and hopefully remission of the cysts that torment me so) before I begin the long journey of starting out with a new doctor. And I knew that before that, I finally needed to talk to the powers that be at Tepe.yac (even though Dr. B never called me, contrary to his promise), so that I didn't spend my whole appointment ranting about administrivia (and loathing. I have so much loathing). And today, I got through to the practice administrator, and had what may have been a productive conversation. But that...is another post.

Tuesday, November 16, 2010

please help - very sad (m/c) question

I am sad to have this occasion to write a post, but there's no font of knowledge (even the very sad kind) better than the blogosphere, as I have found many times.

Friends of my husband's have miscarried twins. All that we know so far is that they are having trouble with their insurance company because of how far along they were in the pregnancy, and (since we're both lawyers - um, completely useless for almost all legal questions, including this one, but other people don't realize that) they've called us to ask for a bit of advice. I am told that insurance "won't cover it" because they were earlier than 18 weeks along, and that "it" costs $15,000.

What I don't know is what "it" is, whether "it" has already happened, what their policy says about it, who their carrier is, or how much before 18 weeks they were. Obviously, these are all the important questions. (Sigh...they're important from the legal perspective. Of course, to this family, all that's really important is that their babies are dead.)

Anyway, here's what I need to find out, insofar as you know, or have heard:
  • How late is it possible to deliver naturally after a miscarriage (rather than getting a D&C)?
  • Are you aware of a post-miscarriage D&C having been covered by insurance (and, if so, by what insurance company)?
  • How much is a D&C (for miscarriage reasons; I understand that the prices on aborting a live baby are completely different) supposed to cost?

For reference, if it matters, I believe the family lives in the Pacific Northwest.

I'm sorry to add so much sadness to everyone's Tuesday. Believe it or not, if only in a very little (and not nearly making-it-worth-it) sort of way, the sufferings experienced by so many of the women I've met through these pages may be able to lighten the burden of another family in this case.

And of course, I am sure they would not turn down your prayers.

Thursday, November 11, 2010

no ideas

I had a lovely chat with a friend of mine from high school. She's a fascinating person, but she and I walked very different roads even then. I had missed a lot of things in her life and needed to catch up. She is coming out of a divorce (her second). She is now seeing a different man, who was, at the time she started seeing him, "married" to a man. (Under what legal auspices I did not inquire.) That relationship - i.e., new guy and his erstwhile spouse/boyfriend/partner/lover - is now over. However, my friend and this fellow have an open relationship; he has had two other lovers in the last year (I did not inquire as to gender) and at this time, their (my friend's and the guy's) relationship is triangular, in that she is also involved romantically/sexually with another man, with whom the first man is working on developing a romantic/sexual relationship also.

She sounds very warm and enthusiastic about how positive and fulfilling these arrangements are - i.e., she does not feel that she's settling because this is as good a deal as she can get. I am certain she is sincere in this; she is always enthusiastic when starting out on new adventures and relationships, and "settling" is not really in her vocabulary. That's definitely something I admire about her, though it leads her to some very odd conclusions.

Read that through again if you need to get the details straight. I'm not sure they're necessary to your understanding of the next part. She told me that she and this fellow (who, she says, is additionally autistic) have talked about having kids together. He has always wanted kids (but assumed he would have to resort to surrogacy, since he is a homosexual...bisexual???). She wants exactly two. I noted that this is not always easy, especially give her significant health issues, and I remembered that she had gotten pregnant and then miscarried when we were in high school. (She graduated high school in 1997, and I believe that was her junior year.)

She told me that she had actually been pregnant several times. At least 2-3 that she is sure of. She's never carried a child to term and has never procured an abortion. I told her that she definitely needs to seek the intervention of a medical professional before trying to get pregnant, as that many miscarriages with no lives births means that something is wrong. She agreed and said that she would definitely be talking to a doctor. Then, quite a few minutes later in the conversation, as part of a different topic, she mentioned that she had had an IUD in for almost ten years.

I don't really have preferences among forms of birth control; first, I don't believe in it, and second, for me, it's entirely beside the point. Society's obsession with contraception strikes me as even more grotesque now than it did formerly. But if I had to choose - in some strange alternate reality, for whatever reason - I would categorically outlaw IUDs. Those things are evil. For one thing, what sane woman would want a metal device hanging out inside her uterus for years and years? Does that sound like it would be good for your body? It does not.

For another thing, as far as I know, the IUDs that do not release chemicals (i.e., the ten-year kind) operate by one means only: they prevent implantation of an already fertilized egg. In other words, they cause an automatic early abortion. (Even ordinary oral contraceptives, if ineffective enough that they do not prevent ovulation, will act as an after-the-fact abortifacient; however, that is not their intended purpose. But I'm shocked how many people take them for birth control and don't know that they do that.) Whatever side of the abortion debate you fall on, I can't imagine anyone not agreeing that a form of birth control that does not in any way reduce the incidence of pregnancy, but deals with the problem by causing a spontaneous abortion of each pregnancy, is a cosmically bad idea.

Apparently several of her children hung on for one or two months before they were aborted. I didn't even know what to say. I was appalled. I thought I would take a neutral position to get to my point, and pointed out that the "miscarriages" she referred to were caused by the IUD, and that it would cause a miscarriage pretty much without fail. And she said that she knew. I get the impression that, had she realized early enough that she was pregnant, she would have had the IUD removed, so that the children would have had a chance at life. She's compassionate that way (I mean that sincerely), but it then confuses me quite a bit about why she wants an IUD in the first place. Isn't this a good case for the pill? Or a diaphragm? I know, a question none of you can answer.

I may have mentioned before that my approach to infertility includes the precept that children are Something That Happens to Other People. Crying every time someone gets pregnant with "my" baby because it was "my turn" would take more time and energy than I have. Besides, when the babies are born, I almost invariably conclude that mine would have been more attractive, more intelligent, or, at any rate, mine. This one is Somebody Else's (like all babies).

So intellectually, I can of course appreciate the irony - you are torturing your body and killing your tiny babies with a horrendous device; I am wishing like crazy I could heal my broken body and I will never be blessed with even a month of pregnancy and would gouge out both of my own eyes before I killed my child in utero. But I can't come up with any emotionally honest statement that it devastates me that she's killing her babies while I can't have any. I won't argue that it isn't devastating objectively; that simply isn't how I feel.

I will certainly acknowledge that I am nauseated by the whole situation. I would be nauseated if I had a house full of children, too, or if I were young and unmarried, or if I otherwise had no children for some non-infertility-related reason. It's just really nauseating, and it's shocking to me that - value of human life questions notwithstanding - it has not occurred to her to see a doctor, get the thing out, and use some form of birth control that will not function in this way. If nothing else (and perhaps there really is nothing else, for her), losing the babies takes an emotional toll on her. Why not avoid that if you can?

I know nobody can really help with this situation and I am hardly asking for advice. I can't necessarily ask for prayers for her situation (other than comprehensive prayers that the situation changes entirely); I can't say that a happy healthy family born to these people would be a sound intention either (I expect their relationship to last 2-5 years and I think that she would not disagree); and I'm not sure she's in good enough health to carry a pregnancy. And prayers for her previous marriages to be reconciled would be equally pointless; the most recent husband didn't want to be married to someone who was sick (she is) and his predecessor was apparently crazy and harmful. Not sure whether either marriage had any canonical validity, but that's getting rather ahead of things.

In other words, I have no ideas. No ideas at all. I am bewildered and sad, but then, I am often bewildered and sad. I do have one thing to say...someone who is categorically infertile would be harmed less than anybody else by an IUD. Obviously such a woman's children would not be harmed, because she will never conceive any. I'm not saying that my friend should be infertile so that I can be fertile and have a family. I'm not going to get lucky enough to trade, obviously. But if there were any method in doling this accursed condition out - any method - it would work a lot differently. That's all I can say.

Sunday, November 7, 2010

letters to God

I have a bunch of theological/spiritual insights of questionable value floating around in my head, ill-formed and half-formed, and which have thus never made it to any format so exalted as a blog post. And I string together a few of them here.

In my little bits of Scripture reading (which I really need to get back up to speed) I saw some passage, from which Old Testament book I can't remember, that essentially set up the construct of a bad shepherd. God was punishing Israel for its unfaithfulness, and the passage sets up an image of a shepherd sneakily leading sheep to the slaughter. Kind of the opposite of the "good shepherd" who is rather more prominent in the New Testament.

It resonates with something else in the New Testament, too:
Or what man is there among you who, if his son asks for bread, will give him a stone? Or if he asks for a fish, will he give him a serpent?
Matthew 7:9-10. Seriously, who would do that? You would, God.

God sent His own Son to die on the cross, and I can hardly demand better treatment for a wretched sinner like me. But the things we've all asked for are as simple as bread and fish - healthy bodies, to bear children to our husbands, not to bring shame and sorrow to our parents and families. We've gotten little else but stones and serpents and scorpions.

When I think about it, there are some prayers I can say every time with great sincerity. The line in the Lord's Prayer - Thy kingdom come, Thy will be done - resonates with me every time. At some intuitive level, I must believe that the will of God for which I'm praying will entail good things - maybe not sunshine and roses, but a reality that I would love rather than hate.

And yet there are so many prayers that I can't say with sincerity because I'm so bitter; because I believe they will be answered in horrible ways, or because I believe they will never under any circumstances be answered, or because I believe nobody is listening at all. I pray them when they're presented to me as part of something proper to do (say, participation in the Mass), but when they are optional, I avoid them. I don't think that prayers of limited sincerity are helpful (though I would happily listen to other perspectives on that point).

I find I can pray to Our Lady because I'm not really angry with her. For whatever reason I guess I don't blame her for this mess. I still pray with great confidence to St. Anthony, who continues to answer all my prayers with faithful promptness. (Apparently I think the prayers' efficacy comes from somewhere other than St. Anthony's boss - since I'm on the outs with Him.) But in my mind, there is a Good Shepherd, Whose will is goodness and would bring joy to my life, and Whose Mother I love and many of Whose saints I trust. And there's also a Bad Shepherd, who showers me with unpleasantness and torment of which I can make little sense, and provides me with challenges a third party might identify as an opportunity for growth in faith, but which have no such effect on me. Who has, in fact, abandoned me and my deteriorating faith.

Theologically, of course, this means that infertility has turned me into a Manichean. That's a touch inconvenient, since I consider that to be a heresy. But that's not the God I profess to anyone who would inquire; it's the God I experience. He's got a split personality, perhaps. Not a lot I can do about that from here.

On the subject of manifestations of the divine with which I currently have less quarrel...have you ever noticed that the very faithful seem to take even (and especially) the smallest things in life as signs of God's providence and communication with them through their daily activities? I used to do that. When I was lonely studying abroad, a particularly beaming smile from a stranger at church or a word of blessing from an old woman on the street indicated clearly to me that God knew I was lonely and wanted me to know that He was there and I wasn't really alone.

Now, I don't interpret anything that way (don't know what I would do with an actual angelic visit, but that hasn't happened yet) - if I acknowledge that God manifests Himself in the smiles of strangers, what do I do with my deteriorating cycle, increasing abdominal pain, and silent treatment from my (Catholic) OB/GYN practice? Assuming that nothing means anything in particular is the less scary and less schizophrenic way to get through the day.

And then I got an email from a friend from law school just this weekend. I haven't talked to him much in the last few years. Periodically this year he's dropped me a line or made a call; he's been struggling to find work for some time now, and I can only imagine how stressful it is knowing he has a wife and two kids who count on him. He is doing his best and so, so patient, but I know it must be hard. And he's one of those people who is naturally and artlessly humble, as I never will be. And heaven knows I didn't ask him for information on devotions. I don't do a lot of that lately. But he decided, entirely on his own, to send me a pamphlet of devotions to the Infant of Prague (Whose precious little statue, sent me by my wonderful prayer buddy, sits next to my bed), and insist that I read it this weekend and say whatever of the prayers I felt moved to for the intention of his job application. I respond really well to direct orders. Open-ended suggestions have little effect.

His email:
I reread the pamphlet I sent you. I remember you said you were seeing a spiritual director to get out of a funk. on page 6 of the pamphlet there is a statement that made me think of you. Under the heading "the Little King's Rule in Catholic Homes", end of the first paragraph. All who approach..., recieve....light in spiritual darkness, streams of grace in dryness of soul...hope in despair.

this is the last time I am going to bug you and tell you to pray to the Holy Infant of Prague. I think He could definitely get you out of your funk. He has been really great to me. I don't know the status of prayers answered per se but I have definitely seen an improvement in my attitude on many things. I would also say I have had prayers answered

So this is your reminder to pray for me this weekend. Also say the prayers for yourself. You can have multiple intentions for every prayer. if you ask Him to help you with your prayer life I believe He will help you. Please don't give up!!

Also St. Gertrude Prayer
Eternal Father, I offer Thee the Most Precious Blood of Thy Divine Son, Jesus, in union with the masses said throughout the world today, for all the holy souls in Purgatory, for sinners everywhere, for sinners in the universal church, those in my own home and within my family. Amen.

the holy souls will be praying for you if you but ask them
have a great weekend with your husband
talk to you later
The pamphlet he sent me is here. I note that on the page he referenced, the text includes the following:
No colic is so painful, no fever so violent, no tumour so malignant, no insanity so raving, no complaint so irritating, no assault of Satan so furious, no pestilence so infectious, no swelling so serious, as not to be dispelled or cured by this blessed Child. The Holy Infant puts an end to enmities, frees prisoners, saves those who are condemned to death, brings obstinate sinners to repentance, and blesses childless parents with offspring. In short, He is become all to all.
I am not saying that I plan again to succumb to the demon hope. I'm not sure I have the courage for that. But even I can't hate the baby Jesus. Maybe if He were walking around with a smug fertile mother in a designer stroller...but with His little repaired hands and His blessings for all the world, no. That particular baby is as much mine as anyone else's (other than Mary's, of course), and I have no quarrel with Him. Perhaps, if not the child I no longer really believe in, He will bring me peace.

Thursday, November 4, 2010

Come to DC! Talk to people who can't have children!

OK everyone. I've emailed the DC-area bloggers I know of, but there may be people I'm missing whom YOU know. Do you have an infertile friend who doesn't really feel up to starting her own blog, but has expressed regret that she doesn't have the infertility support community that YOU have? And does she live in the DC area? I thought so. You should tell her to come meet us for coffee on Saturday (THIS Saturday) at 10AM. You just email me and I'll send you all the details.

Oh, what's that you say? You don't know any infertile women who live in the DC area, but you just so happen to be visiting the area yourself, this very weekend? What perfect timing. You come, too! Just email me and come join us for coffee.

Finally, to you, charming people, who have never read an infertility blog in your lives (and might never do so after this minute), but for some reason just today happened to be googling "DC area infertility support group," is today ever your lucky day! You just drop me an email (it's linked through my profile - click over on the right) and mark your calendar for Saturday at 10AM. And have coffee with a charming group of zany infertile women.

You know you want to. See you Saturday...