The light of a thousand suns
At 6 days past transfer (dpt), I was feeling viciously low. Not only was I sad, I was angry, flying into rages at the slightest provocation. I can't be sure, but I think that was the day Paul, a genius of self preservation, began wearing a cup.
At 7dpt, I went to my local RE's office for the luteal phase bloodwork Cornell requests. I saw only the phlebotomist, who gasped sympathetically at the bruises that linger at my every venipuncture site. Even with this limited exposure, being in the local office did a number on me — it's been the site of too many disappointments. On the drive home, I was seized by a panic attack, and had to pull over as I hyperventilated, telling myself over and over, "We have burned through over $40,000 with nothing to show for it."
Okay. So I didn't test on 7dpt, knowing that seeing a negative would only fuck me up even more.
Good thing I didn't, because it would have been negative.
At 8dpt, I woke up early. Now, I do this during the two-week wait (and beyond, if the situation warrants it). I wake up to use the bathroom or to bat away the rough-tongued attentions of the cat, and I can't go back to sleep — my mind is too busy, considering every possibility, running endless diagnostics on my every reproductive apparatus. I went to the bathroom, returned to bed, and tried to go back to sleep, but finally gave it up as a bad job at 5 AM. And I lumbered off to the second bathroom to christen the first stick of IVF #4.
You have never seen a fainter positive in your life.
To see a second line, you'd have needed NASA-grade optics, the ability to convince yourself that the Earth is flat, and the light of a thousand suns. But there was a second line.
I stared at the line for about an hour. By 7 AM I could wait no longer, and made my poor beleaguered husband wake up, put on his reading glasses (or as we call them in these days of PIO, his stickin' glasses), and stumble into the bathroom for a consultation.
Paul: [Stares fixedly at test. Stares at the negative. Stares at the new one. Stares some more. And more. For about an hour.] Well... [Pauses for another hour and a half.] I think there's something there...
I spent the rest of the day in the bathroom, staring, boring a hole in the test with the force of my gaze. The thing practically started to smoke, so powerful was my concentration. (And, really, nothing says home like the smell of burning pee.)
At 9dpt, I repeated the experiment. The second line was darker, though still quite faint.
At 10dpt, 5 AM found me once again crouching over a stick. The second line was darker, clearly visible to the naked eye without too much suspension of disbelief.
No doubt about it. Positive.
But this morning, 11dpt, something terrible happened. My friends, I hardly know how to talk about this, so I'll just come out and say it:
I ran out of sticks.
The last two days have terrified and reassured me by dizzying turns. My pelvis feels very busy — fullness, twinges, and cramping, which could be the earliest signs of pregnancy, or could be the earliest signs of a pregnancy ending. I'm tired, which could be an indication that I'm very busy on a cellular level, or could be that I haven't slept past 5 AM once in the last week. And my breasts are the slightest bit tender, which could be the effects of increasing hCG, or could be the consequences of pummeling them hourly to check for soreness.
This could mean anything.
I have enough experience — in fact, we all do — to recognize that a positive HPT doesn't guarantee anything, not even a decent number on a quantitative blood test. Believe me, of that I am painfully and queasily aware. I am about five minutes pregnant, the littlest bit, and from here anything could happen.
But just as anything bad could happen at this point, so could anything good.
I wasn't ignoring you
...I was just very busy.
First I had to puncture the local lab director's tires with an icepick when it became clear that the staff had gone home yesterday without making sure my bloodwork results had been faxed correctly to Cornell. They'd been sent to the wrong number.
(But, hey, that's okay. No problem. I can wait to learn the results of my pregnancy test after my fourth fucking IVF. Take your freakin' time. That big label that says STAT is really just a serving suggestion.)
Then I had to tip five pounds of sugar into the gas tank of the customer service representative who sent the results to the wrong number again, despite the fact that the correct number was printed in big bold type on the order itself.
(Sure, anyone could make that mistake. I can totally see how you'd fax the results to the wrong number, even after the patient calls twice to offer gentle encouragement and positive reinforcement, making sure you have the right number. Happens to the best of us, I am sure.)
Then, still not done with my spree of vehicular mayhem, I was obliged to shoulder a tire iron and work a pattern of delicate, lace-like cracks into the windshield of the receptionist at Cornell who wasn't able to give me my results, telling me I needed to wait an hour and a half until the on-call nurses began taking calls. I hated to do it, because she was very kind, but I try to be consistent in my vengeance.
(After all, why should I expect to get straight information about my own medical records in a swift and timely manner? It's not like it's my body or anything. It's not like my medical records are my legal property or anything. Of course they wouldn't want to give results to just any old patient without appropriate vetting and strict adherence to procedure. I could be a terrorist, for God's sake. Only a filthy liberal would expect otherwise. Julie, why do you hate America?)
Then I had to rest. Engineering all this chaos takes it out of a girl.
Now, at last, my agenda is clear and I call tell you that I finally learned this morning that my hCG level is a comfortable though not extravagant 107.
My clinic likes to see anything above a 50 at this point; if you clear that threshold they don't do a repeat test for another week. That might be a good thing. It will give my victims time to perform the necessary repairs on their automobiles, so that I might start fresh again next Monday.
On the one hand, I couldn't wait to go in for my second hCG test, the one that would reveal whether my levels were increasingly appropriately. "Knowing won't change anything," Paul pointed out with his customary and damnable good sense. But that's not entirely true. If it's good news, knowing will reassure me, inasmuch as anything could right now. And if it's bad news, I would rather have some kind of warning. I'd like to have time to stock up on vodka and Cheetos.
On the other hand, I dawdled this morning as long as I could before heading in to get blood drawn. Once I was at the lab, I hid in the bathroom when they first called my name. And then, once stabbed, I bled as slowly as I could. (Think clotty thoughts. Fibrin. Scaaaaaabs!)
I realized I don't really care to know, after all. I can't really believe the best yet, but neither am I eager to confirm the worst, if it's going to come to pass.
365. A healthy number with a doubling time of around 40 hours. Entirely acceptable. Even dare I say it? encouraging.
A modest celebration is in order. Do you think they make prenatal Cheetos?
I'm here, but I'm quiet. I've gone overnight from a woman who can't stop talking to one who can't stop shutting up.
Part of it is that I don't know what to say.
This pregnancy is new enough and precarious enough that it isn't funny yet. I hardly dare to think about it yet, much less make fun of it. I do think about it, in an unintentional daydreamy way, but when I realize I'm doing it I feel a surge of panic, as if suddenly realizing I've done something wrong. (See also: Leaving Chinese porno on my mother's kitchen counter overnight. But I swear there was a perfectly good explanation. It wasn't mine. I swear.)
While I don't have much to laugh about, I know I also have nothing to complain about. When articulate bitching is your stock in trade, what's there to say once you get what you want? Not much. You just sit still, biding your time, afraid to accept your good fortune but not so foolhardy as to question it aloud.
Another part of why I'm quiet is that I don't know how I feel.
It feels churlish to admit this even to myself. I almost can't believe I'm confessing it here, in the face of my friends who would be only too thrilled to be in my position. I'm ashamed of what looks a lot like ingratitude. But the truth, which I occasionally try to tell, is this: I am not as happy as I expected to be.
I've worked and waited. I've wanted this for so long. (It's the baby I truly want, but I am told by reliable sources that those are usually preceded by a pregnancy, so, sure, we'll say I wanted that, too.) So why can't I get happy?
It's the wearing nature of anxiety, which exists at such a constant level that it mutes all other emotions. It's not just the fear of another loss, although that looms large and frequently spikes to stratospheric heights. There's also the deeply ingrained mistrust of my body that doesn't quite allow me to believe I'll manage pregnancy and delivery without mishap. There's the apprehension inherent in facing something new I don't even know how to be pregnant, to say nothing of how to raise a child into a likeable, happy person who's kind to weaker creatures and votes against the Republican party. And there's the chilling awareness that our lives may soon change dramatically, forever, in the good ways we've hoped for but also in bad ways we can't foresee.
Oh, yeah, hey, have I mentioned the ambivalence?
Those feelings are background, a constant white noise that becomes so familiar it starts to feel like stillness. Beneath it all I know I am happy, somewhere; I know this because I do catch myself dreaming now and then. I just can't easily access the joy I expected to bubble up unbidden.
Finally, I'm quiet because I don't know where I belong.
Since I started treatment I've been that oxymoronic anomaly, a fertile infertile. I've gotten pregnant now after three out of four IVFs. Without a baby to show for it, though, I could still commiserate with women who'd racked up negative after negative; although I hadn't had their kind of disappointments, I'd had my own, and I felt we understood each other.
At the moment I'm uncomfortably aware that a pregnancy sets me apart from the people I care about. I feel your pain because I love you, and because until, oh, two weeks ago, it's been my pain, too, the same agony I've felt for the better part of three years of treatment. But I've been granted a reprieve from the sadness that many of you still face on a relentless daily basis. It's a welcome reprieve, to be sure, but one that makes me uneasy, too. How can I sympathize now without awkwardness? How can I tell my infertile friends, "I know what it's like and I'm sorry," when you could fairly answer, "What you know isn't true anymore"?
I feel out of step with most of my friends. I want to be clear about this: I don't feel guilty, and I don't feel unworthy. But I do feel lonely (excellent company notwithstanding). I've gotten such comfort and pleasure out of experiencing infertility with you that I desperately wish we could all be simultaneously going through the resolution to it together, too.
So if I'm not in synch with my barren pals, where do I fit? I'm pregnant enough to feel like a sudden outsider among the infertile. But I'm also experienced enough to feel deeply reluctant to join a cheerful group of optimists at a similar stage, comparing symptoms and ultrasound measurements.
I am somewhere in between. I'm quiet. I'm still. But still here.
I live half an hour from a small city by a big lake. We're there a lot for shopping, dinners out, and visits to the local RE. I love the lake; since the shore is only a few blocks from downtown, we visit it often, watching the boats bobbing in the marina, kids playing in the sand of the tiny man-made beach, and the squadron of mallards who nest in the rocks.
Last summer, on a sunny day when I was about seven weeks pregnant, Paul and I went for an ultrasound. We saw the heartbeat, just as we'd hoped, then went to see the ducks.
Hatching happens late up here; by mid-July the ducklings are still small and downy, entirely dependent on their mothers, staying very close to shore. We watched those tiny ducks for hours, not talking much. But then we didn't need to talk, since we knew each other's thoughts we were happy, we were hopeful, and we were finally part of the business of life in a way we'd never been.
C'mon: pregnant. Heartbeat. Ducklings. Sunshine. It doesn't get better than that.
Two weeks later, everything was different. We'd lost the heartbeat. It's what we expected; we were prepared. We asked for a D&C.
I could have one that day if I stayed nearby, waiting my turn for an empty OR, so we didn't drive home. We waited downtown, the longest wait of my life.
And of course we watched the ducks. They were two weeks older, a little less downy and a little more assured. They swam farther out from shore and picked fights with each other. When their mothers approached to deliver a disciplinary peck, they tried hard to swim away. We could see their tiny feet churning fast in the clear lake water.
And again, we didn't talk much. Again, there was little to say.
I didn't see the ducks again before winter came in. I thought I would today. We went to town for brunch and shopping. Before we ate, we changed tables at the restaurant to get a better view of a sleeping infant. As we shopped, we slowed (though did not stop) as we passed the baby clothes. Then we split up, agreeing to meet in an hour's time.
As soon as we'd parted, I went to the bathroom and saw that I was spotting.
There was only the faintest tinge of beige on the toilet paper, more staining than spotting, thin and very light in color. I sat in the stall staring at the paper, reminding myself of what I already know: brown blood is old blood, less ominous than red. Many women spot throughout successful pregnancies. Bleeding isn't necessarily a bad sign.
But I also know that blood of any color is never a good sign. I know that about half of the women who experience bleeding will go on to miscarry. I know there's nothing I can do but wait.
So I sat in the stall and I cried for a while. I thought of Melissa, I thought of last year, and I thought of the ducks on the lake.
When Paul and I met once the hour was up, it was chilly and looked like rain. We decided against going down to the shore and came straight home instead.
It feels good to breathe again.
Beta #1, 11 days past transfer: 107
Beta #2, 14 days past transfer: 365
Doubling time: 1.69 days
Beta #3, 18 days past transfer: 3,565
Doubling time: 1.21 days
I think we're in pretty good shape.
This morning I was up at 4 AM, awakened by anxiety. My ultrasound was scheduled for 9 AM. You would think with a 5 hour lead-in I'd be able to arrive on time. Ah, but no. I was my customary five minutes late. This worked out well because my clinic was its customary 45 minutes late.
I usually don't read magazines in the waiting room. I am far more interested in what's going on around me. I am an avid spectator of life's rich pageant. Either that or I'm one nosy sonofabitch. You decide.
Today I noticed a couple who were there for a prenatal checkup. The woman was heavily pregnant, sheathed in bicycle shorts that probably fit like a glove a latex surgical glove several months ago. Now they were stretched so tightly that the tensile strength of the Lycra was severely compromised; you could practically hear the twists of space-age polymer pinging under the strain as she settled into her chair.
She was also wearing a T-shirt that fit snugly across her abdomen. It was emblazoned with a flaky-looking iron-on that read, "FUTURE BIKER."
I think I will make myself a maternity T-shirt that reads, "SECOND MORTGAGE." With glitter. And perhaps, if I'm feeling kicky, fringe.
Her partner blew his nose noisily into a Kleenex, which he then crumpled and attempted to loft across the room into the wastebasket. That's right, shooting snotty hoops in a doctor's office. I am sorry to report that from his overly ambitious position way outside the key, his shot was a disappointing airball.
Paul and I have grown careless. We started this pregnancy with firm resoluteness: we would be cautiously optimistic. We would wait and see. We would take it one day at a time. We would not, under any circumstances, count our chickens before they hatched.
But since my last hCG test, we have become that most dangerous of breeds: we have become reckless and unapologetic chicken-counters.
It began innocuously enough. First we didn't refer to life after February at all. Then, once we'd dared to begin doing so, we were careful to preface our remarks with, "If this pregnancy continues..."
That felt pretty good.
It snowballed after that. Before we knew what was happening we were planning projects, talking about middle names, agreeing that it would be nice to have a baby in winter when it feels good to hibernate. All of a sudden we were acting like we believed everything would be all right.
It's a happier way to live than waiting for disaster. I believe cautious optimism is impossible undesirable, anyway. Why would I want to deprive myself of hope or love?
Everyone has always been kind to me at my local clinic. I feel well cared-for there, despite the visceral terror I feel every time I step off the elevator; although I've gotten very bad news in those examination rooms, I still trust in the good intentions of the people who work there. Every doctor and nurse who passed said hello to me as I waited, greeting me by name. HIPAA or not, I count on that.
When I was alone with the nurse, I confessed about the blood. I'd had only meager faint staining over the last few days, but early this morning I had a single episode of true spotting, dark brown blood on the paper as I wiped. The nurse looked grave and said she'd tell the doctor.
"I'll tell you what I see as soon as I see it," the doctor promised as I lay back on the table. My fear must have been obvious. (Maybe it was my saying I was terrified that tipped him off.) The wand went in. Before it had even been fully inserted, he said, "Singleton intrauterine pregnancy with a yolk sac, sized consistent with dates."
So far everything is fine, aside from the spotting.
A more leisurely look confirmed the presence a nicely shaped gestational sac; a round yolk sac; and a thickening on one side of the yolk sac, the embryonic disc, the part that will become, um, a person. Everything is measuring exactly according to dates.
No reason for the bleeding was evident, though the doctor murmured something vague about a friable cervix. Any unexplained vaginal bleeding during pregnancy is called a threatened abortion. (Shout out to my friends, you habitual spontaneous aborters, you.) The silver lining to all this for if there is one, I can be counted on to find it is that with that diagnosis, I can avail myself of all-you-can-eat ultrasounds, and my insurance company won't turn a hair.
"I'll see you tomorrow," I told my doctor. He thought I was joking, but did look a little alarmed when I asked him how much an ultrasound machine would cost.
I've mentioned before that any unexplained bleeding in pregnancy invokes the diagnosis of threatened abortion. This is an awful term, accurate though it may be okay, it's no habitual aborter, but it does have a certain je ne sais quoi.
Oh, who am I kidding? Je sais exactement quoi. When my doctor coded my file at the end of my last appointment, he said, rather offhandedly, "Don't freak out, but I'm writing in threatened miscarriage." Did he realize, I wonder, that he was dangerously close to threatened spasmodic-kick-in-the-teeth-from-a-woman-still-in-the-stirrups? Threatened keening-so-otherworldly-it'll-cause-every-patient-within-earshot-to-empty-bladder-uncontrollably? Threatened calling-every-day-tearfully-begging-for-a-repeat-scan?
Because that's where I am at the moment. Every day I don't call and ask for another look is a victory much greater than I can describe, a triumph of my own superhuman willpower over my also superhuman fear and sadness.
"It's still very early." Got it. Thanks.
There is a scary, mine-littered no-man's-land between being treated for infertility and being securely pregnant. I don't mean the social divide or the disconnect that exists in my own mind I speak of the medical limbo you enter between a positive pregnancy test and your first visit to an OB.
I'm still seeing a reproductive endocrinologist for early scans, but, really, that's by default; once we've established that I'm pregnant and it hasn't implanted anywhere unorthodox, their work is done.
Sometimes that fact is uncomfortably obvious. Yesterday, after I'd left a couple of increasingly panicky messages, I finally spoke to a nurse. I told her about the staining I'd been experiencing and asked her whether it could be ascribed to my progesterone levels.
The nurse was unconcerned. I don't mean she was soothing and reassuring and told me I shouldn't be concerned. I mean she was unconcerned. I'm already on the highest dose of progesterone they prescribe, she told me, and I'd had a reassuring ultrasound. "We have no reason to think anything's changed," she said.
This reassured me for about half a second. But because apparently it's against some industry-wide ethical code to leave a patient feeling less than the maximum allowable amount of bone-deep terror, she continued with a warning: "Of course, it's still very early and anything can happen."
Yeah. Thanks. Third pregnancy, no babies. I'm reasonably clear on that point. 'Preciate the reminder.
What she said is true: we have no reason to believe anything's changed. (We won't discuss my suspicion that my breasts aren't as tender today as they were yesterday. We simply, absolutely will not.) So why am I not content?
I keep coming back to the fact that last time, I had no indication that the pregnancy was failing, even beyond the point where the embryo had died. No news is not necessarily good news.
There is nothing to do but wait, of course; I am trying to do so with grace, but failing. What we need is someone whose job it is to follow women from infertility treatment to the point where they feel confident in their pregnancies, to fill the gap between RE and OB. Someone to be reassuring where appropriate, but never unrealistic kind but pragmatic, hopeful but sane. Someone who will distract and amuse, sympathize and encourage. Someone who gets paid to do what my friends here generously do as volunteers.