Dear doctor, Knock it off. Anxiously, me
At the doctor's office today, I was marveling aloud at the size of the blob of tissue I'd expelled. My doctor said, with just a little too much eagerness, "Yeah, if we'd left it alone you probably would have had a rupture. It sounds like you were pretty close."
Um. Yeah. Thanks. Listen, next time could you say something, you know, reassuring?
Do you think maybe I've given an incorrect impression of how well I'm handling this?
What I thought but didn't say
Doctor: So how are you?
Julie: I can't even talk about it.
Doctor: You know, I can offer you better living through chemistry. Prozac?
Julie: No, thanks, but I am hearing a lot of good buzz about heroin...
Topics that have recently come up in conversation while an ultrasound wand protrudes from my vagina:
- the novels of Thomas Hardy
- sexual dimorphism in ducks
- the systematic attempts to stamp out French in 1970s Louisiana
Just a little off the top
I have learned something new. I have learned that some women get pretty for their doctors. Not only a good wash and maybe some hasty leg-shaving which is as much as I ever do but pedicures and bikini waxes to boot.
But I can't figure out why. Do we think our doctors are looking?
I can see how you might feel the urge to spruce up the place if you thought the person rooting around down there was actually interested. But I just can't imagine my doctor is. In his long career he's faced down vulva after vulva after vulva so many that he doesn't even need to cast a downward glance while introducing the ultrasound probe. In fact, I'm pretty sure he could do it blindfolded, backwards, with one arm tied behind his back. Hell of a parlor trick. Life of the goddamn party.
Or maybe we're talking curb appeal. If I put out a nicer welcome mat and a couple of pots of geraniums, are my embryos more likely to decide that my uterus is a nice place to raise a family? One chipped toenail and there goes the neighborhood.
Or maybe it's part of some obscure pagan ritual. Maybe a neat pelt pleases the gods, but an unruly thicket calls down their mighty wrath, guaranteeing everlasting barrenness. Weren't human sacrifices washed, shaved, and oiled so that the gods might find them tasty? Maybe it's like that.
Look, if I thought my doctor actually noticed, I might be more invested in presenting a pleasing pubic picture. (I doubt it, but I suppose it's possible.) But he couldn't pick my pudendum out of a police lineup even if he had a crooked cop whispering in his ear. He doesn't even pronounce my name correctly, for God's sake. Why should I imagine he cares about my lovely, lovely crotch?
Go with the flow
I haven't said much about the follow-up consultation I had after IVF #3 for the very simple reason that it yielded almost no new information.
When Paul opened his notebook at the beginning of the meeting, my doctor's eyes landed on the Cornell letterhead with the fixity of a soaring condor spotting a choice heap of carrion way, way down below. For the rest of the hour, his sights were locked.
So we got to hear a lot about what he imagines they'll tell us at Cornell, his impression of the doctor we'll be seeing, and his opinion on the cost of their program. When I was sufficiently bored beyond politeness by all this, I finally barked, "Thanks. Now. Less about their approach and more about yours, please."
As expected, he warmly embraced my idea that stimulated IUIs might be worth a try. Although I had several unsuccessul IUIs with Clomid, the only way I've ever achieved an intrauterine pregnancy was with gonadotropins and an IUI, so it seems worth a couple of tries. I can't tell if my doctor's enthusiasm is due to a sincere belief that it might work, or relief at the prospect of shifting the burden of conception back onto my body instead of his lab.
He assured me, by the way, that his embryologist was not drunk when she did ICSI on my eggs.
Speaking of my eggs, he took vigorous exception to my characterization of them as garbagey. I contented myself by scowling and muttering under my breath, "They're my eggs and I can call them whatever names I want."
I'm pretty much the epitome of maturity.
He allowed that the zona problem I have is uncommon, and offered no opinion on whether my eggs might perform better in vivo than they do in vitro. This pretty much cemented my conviction that going to Cornell for a second opinion is a good idea I'd like to talk to someone who's seen a hundred patients like me. I know no one can offer any guarantees, but even an educated guess would be an improvement.
We had a long and confusing conversation about whether I should have another lap before further treatment. I was finally made to understand that my doctor's opinion is that if we're ready to forego future tries with IVF and just concentrate on IUIs and/or natural conception, I should consider a lap. But if we're willing to consider IVF in the future, we should leave the depths of my pelvis unplumbed, for fear of removing functioning ovarian tissue. "...Unless," my doctor concluded, "you really want a lap."
For the girl who has everything, I presume.
So the consultation didn't offer us anything much beyond confirmation of what we already knew, and had already considered trying next. Inasmuch as there is a plan, here's what we've decided, in helpful flowchart form:
For the record
Among the photocopied pages from my file is the psychological evaluation the state requires before a couple undergoes IVF. I should note that said evaluation was performed by one of the cadre of skilled and caring mental health professionals getupgrrl captures brilliantly, velveteen and all.
I will treat you to some highlights from the report, with my comments:
They report they currently have a nice lifestyle and are not 100 percent convinced that they desire to be parents... I felt it would be dishonest not to acknowledge some reservations about the ways our life would change. We do have a comfortable life (I would never have said "lifestyle"), and children will change that drastically, in some ways for the worse. Funny, though I never saw this as a sign of ambivalence, as the psychologist clearly did. I saw and see it more as a gesture toward pragmatism, and possibly a sign of our true commitment to having children, even though we know we'll be losing some of the things we love about our life together.
[Julie and Paul]...report a history of anxiety and depression which they seem to be managing quite well together as a team...They both deny low self-esteem...Both deny thoughts of death and suicidal ideation. No evidence of delusions or hallucinations. Oh. Good. Not delusional. Whew. And if you were looking for problems with my self-esteem, it's not low you'd need to worry about.
[Julie and Paul] are a couple coming to seek fertility treatment but with expressed ambivalence about the procedure... I think you'd have to be a nutjob fruitbat wingnut not to feel ambivalence about the procedure. They stick needles into your ovaries, for crying out loud.
They do have concerns about the new responsibilities of having a child. I think their ambivalence will enable them to accept the results of any negative outcome of this treatment. This bit near the end sent me into a rage last night, and I find myself getting sputtery about it again. Can you see why? Wait, I'll rephrase it to make the infuriating part obvious: Because they're not sure they want a child, they will breathe a sigh of relief if this voodoo shit doesn't work. First of all, we are sure we want a child, and recognizing that it won't all be moonlight, roses, and unsoiled fuzzy sleepers doesn't dull that desire. Second, I defy anyone to "accept" the "negative outcome of this treatment" the many Gothic ways in which things have gone haywire for us this year with anything but rage, anguish, and a feeling of powerlessness so profound that I can barely make myself pick up the phone to order the next round of drugs. If my "ambivalence" makes this easier, I'd hate to see how people with "delusions or hallucinations" about the romance of parenthood handle it.
If I can make it there, I'll make it anywhere
We're heading to New York this morning for a couple of days of psychological hardening before Tuesday morning's consultation at Cornell. I will nurse my feelings of alienation among crowds of happy tourists. I will practice my snarl on blameless strangers. I will hone my anger at the universe as some clueless jackass on the subway refuses to let me off at my stop.
Can you tell I used to live there?
Back late Tuesday night, with an update to come on Wednesday.
Confusing the issue
You know, doctors can be a slick lot, especially reproductive endocrinologists. They have to be, I guess, if they're going to manage to convince you to hand over considerable sums in exchange for absolutely no guarantee. Usually it annoys me — the refusal to commit to a position, the mincing of words — but on Tuesday it entertained me. I loved watching the doctor furrow his brow as he read my chart, and hearing him finally settle on a non-actionable way to ask, "What the hell did they do with you?"
What he said at last was this: "I'm seeing certain things here that confuse me." (I can just see myself telling anyone who will listen, "You know, they're supposed to be really good at Cornell, but I don't know — this guy just kept saying how confused he was.")
The doctor we spoke to was adamantly opposed to the notion that we should even consider donor eggs at this stage. Given my age (almost 33) and my FSH (6.7), he said there was no reason to believe my eggs are unsalvageable. When I asked him about the notations in my chart, which indicate that many of my eggs seem to have defects beyond the whole weak zona question, he paused to frame his words, then said, "There are so many human factors that influence the IVF process. I would look to those, rather than to biological ones" to explain the problems I've had so far.
And on the whole weak zona question, he communicated the same thing. His theory was that I'd been triggered too late, that the eggs that ruptured were post-mature, on their way to degrading when the ICSI process finished them off. They tend to trigger earlier at Cornell, with daily monitoring near the end of the cycle.
I asked him if he'd ever seen a patient with a persistent weak zona — a problem that manifested itself over repeated cycles. He said they'd had one patient who never made any zona, a problem so rare that "we wrote a journal article about her," but no one with intrinsically flawed zonae. He repeated his comment about the human factor.
He also said he would recommend decreasing the medication as the cycle progresses, and would opt for a pure FSH protocol rather than combined FSH/LH as I've had in the past. But he didn't recommend anything arcane, and seemed to think a simple approach could work for us.
And I am beginning to think so, too.
My feelings about my reproductive endocrinologist are occasionally quite negative. But I swear it isn't personal.
In fact, on a personal level, I'm crazy about him. He's a lovely man who's shown me great kindness on many occasions, the sort of kindness I needed when everything went haywire: laughing dutifully at my feeble attempts at humor when most people would have been horrified. He has never shied away from the questions, complaints, and occasional abuse with which I've ambushed him. Although some of the decisions that have been made about my treatment have turned out very badly, I can't doubt the purity of his motives or the goodness of his intentions.
Based on a careful study of my journal entries (and recollection of a very few bizarre and smoking-hot dreams), I've concluded that the spikes of annoyance I've experienced over the last few months are really nothing personal. I've found that the intensity of my feelings correlates directly with the success of a given phase of treatment.
Thanks to the magic of Microsoft, I have prepared a chart that proves this, including several important milestones over the last two years. I feel it's quite persuasive.
Day 7: "Ah, my arch-nemesis. We meet again."
I have decided that the doctor who did today's ultrasound is my sworn bosom enemy.
I'd already taken against her for her dippy behavior when we learned my last pregnancy was failing. And I'd been exasperated when, before IVF #3, she couldn't figure out how to work one of those newfangled, high-tech blood pressure cuffs. (Special hint, doctor: It's called Velcro.)
But today she just pissed me off more.
First she didn't even try to show me the ultrasound screen as she scanned me. "I'd like to see, too, if we can angle the monitor," I asked, knees akimbo. "Sorry," she said, "but if we angle it, I can't see." Of course, every other doctor in the practice and I assume the ASRM has figured out where to stand to offer the patient a look without compromising the doctor's view. Maybe it's unreasonable of me to want to see what the doctor is basing her decisions on. Maybe it's presumptuous of me to want to see my own engorged ovaries.
But that's not what really sent me stratospheric. That came later, when I asked a question and she looked at me vaguely, asking, "Have you done IVF before?"
The IVF coordinator and I were both surprised into silence by this question. I finally mustered an annoyed snicker in answer. "Um, yes."
Now, okay, I realize this is not, alas, a Juliecentric universe. While I do have some nominal control over the tides and the changing of seasons, the rest of the world does somehow manage to turn without my express consent. But come on. "Have you ever done IVF before?"
My clinic does no more than 150 cycles a year. Three of them last year were mine, and each of them went haywire in a different and unusual way. For one of them, she did the retrieval. On another, she presided with unseemly cheer over a very disturbing ultrasound. And then there was that very tense conversation about my egg quality after IVF #3 she got defensive, I got mad, and we both went away feeling misunderstood.
Either I'm really unmemorable, or she's a total goddamn space case.
It doesn't feel good to know that a doctor who's empowered to make decisions about my treatment doesn't know who I am or why I'm there. I'd expect that in a larger practice, might even prefer it at this point the personal touch has proven so far to be a bad, bad touch. ("Julie, show the nice police lady where the scary people touched you.") For added expertise, it would be a worthwhile tradeoff. But if I'm not getting state-of-the-art care at the moment, at the very least I expect the doctors to act like I matter.
So, without further ado, I declare a blood feud.
The scan and bloodwork looked fine. My follicles are growing apace and it looks like we may trigger Sunday night. Next appointment: Sunday morning, 8:30. If they're running late this time I swear I will commit mayhem.