Liebster Blog Question Challenge

1. What did you want to be when you "grew up"?

 - a princess.  Seriously.  But also a professional reader.  As in, if somebody would just pay me to read good books all day, I'd be delighted.  I quickly realized that wasn't a realistic possibility, and settled on a doctor.  Which is where I am today, and honored and amazed (almost) every day to don the white coat.
2. What was the last book you read, and what did you think of it?

 - currently almost finished with Charles Dickens's Bleak House.  It's lovely, as all his works are.  I love the way he intertwines the different characters' lives and the breadth and depth of his stories.  I also love the wit and the timelessness of his plots.
3. Ditto on the last movie you saw?
 - Les Miserables, the adaptation of the musical.  Generally I liked it very well.  Anne Hathaway was a stunning Fantine, and her demise was done so well.  Young Cosette and Gavroche were also great.  I found Valjean and Javert's singing lacking compared to the musical, but otherwise it was very well done if a bit heavy on the Christian symbolism.  Altogether: worth the investment.
4. Name a place you like to visit, and what you love about it?
 - Israel.  No question.  I love the warmth of its people, I love Hebrew, and I love the way I feel so at home there.  Choosing a specific place within Israel is trickier.  Obviously the kotel (aka the Western Wall) wins out.  After that, though, I really love Machtesh Ramon (מכתש רמון) at night when you can stargaze, and the Galil and the Golan because the green and the mountains are so beautiful and majestic.  There are some breathtaking hiking trails, and a breathtaking (in a more literal sense) ambulance ride from Kiryat Shemona to Tzfat (aka Safed) that I used to do when I volunteered for MDA.
 - Outside of Israel, I absolutely love Tuscany.  Dear Husband and I once rented a villa and it was the most romantic and beautiful place, and there is so much to sightsee as well!  Also the Dolomites are beautiful and the air is so crisp and clean!
5. What are you grateful for?
 - Family.  I have the most amazing, loving, wonderful family ever.  Tfu tfu tfu, kinehora, בלי עין הרע
 - Being a physician.  I get to go to work every day to try to save lives.  It doesn't get better than that.  To me, being a physician is a calling and I am continuously humbled by the trust patients place in me.
 - A really good cup of tea.
 - A good book.
 - Shelter and food and clothing, and the fact that (thank God) I don't go to sleep worrying whether I will have these things the next morning.
6. Describe your ideal Saturday night?
 - Depends on my mood.  Tired or depressed?  A good cup of tea and a good book next to the fireplace.  Happy?  Dancing with my husband :o)  (And then afterward, probably a book).
 - Generally NOT BEING ON CALL
7. What is something you remember loving as a child? (a favourite book, food, place... you get the idea)
 - my nunny (what my family called our security blankets)  It was light pink, and yes, I saved it, and still have it, though I don't sleep with it (day after losing Peanut excluded)
8. Have you made any New Year resolutions? (If so, please share)
 - Be more grateful, and complain less
 - be kinder and more generous
 - no speaking ill of other people!
9. Name 3 blogs that you follow, and why you love them
 - A Thousand Oceans because her story has similarities to mine, and we have the Israel connection, etc
 - Stirrup Queens because Mel is funny and thought-provoking
 - Unaffected by You
 - No Good Eggs
10. Favourite ways to relax?
 - Shabbat dinner with my family
 - Reading
11. Something in life you would like to master but haven't quite got there yet?
 - Other than infertility?  Haha.  That's easy: I want to be a truly excellent physician, and a truly excellent writer.

And there you have it, folks!  Hope your weekend is going well, and שבוע טוב

After a long reprieve: some infertility humor, and Israeli movies I do and do not recommend

I'm sitting on my living-room sofa, nursing a cup of tea and watching the snow fall.  Dickens himself couldn't be more satisfied.  While I obviously don't celebrate Christmas, I staunchly believe 25 December should be snowy white.

Dear Husband's parents arrived yesterday from Israel and we have had a lovely visit thus far.  The volume of the house has, however, risen several decibels.  That's what happens when you deal with Israelis.  But I love it.  I've tried to tidy in bits and pieces to keep it manageable.  Having two extra people in the house nudges us toward entropy, to put it scientifically :o)  We had an especially cozy night last night with a fire in the fireplace, me snuggling next to Dear Husband on the sofa, and watching בוקר טוב, אדון פידלמן.  I can't actually recommend the movie even to those of you who understand Hebrew because I didn't feel it came together well.  I do, however, HIGHLY recommend the hilarious if completely sacriligeous and crass זוהי סדום.  I promise, you will NOT be disappointed.  It stars the cast of ארץ נהדרת, need I say more?

I realize this blog has been woefully lacking in humor lately.  For shame, Mim!  I haven't got anything hilarious up my sleeve, but we will try.

Holiday gifts/activities for the infertile, particularly she with any form of premature ovarian failure:
1. chocolate and wine (no explanation needed)
2. a carton of eggs (can't use them for IVF, but at least you can bake a cake to eat during your pity-party
3. baby powder (just add water?)
4. a test-tube ornament -- looks great when complemented by silver tinsel
5. For us Jews, use the test-tubes to make a Chanukiyah (aka menorah).  I recommend tossing the traditional olive oil and burning baby oil, of course!
6. Decorate your negative pregnancy tests with glitter and hang them as ornaments.
7. Pomegranates (going biblical never hurts)

Hope that was good for a few laughs!

On Depression and on What it Means to be Infertile. (Warning: self-pity alert!)

I am still trying to battle the despair, and it's a struggle.  Even if I lift my mood temporarily through dance, or music, or exercise, in a matter of hours (at most) I am my same depressed self.  One can only fight so many hours a day.  It's exhausting.  And yet I told my internist/mentor (who I hope is having a wonderful, warm, blog-free vacation right now) that I don't want to take an SSRI.  Partly it's the side affects -- I refuse to be somnolent and weight gain is absolutely out of the question.  But more than that -- I want to get through this myself.  I need to believe in my ability to overcome this feeling.  My body is defective (thanks, genetics!) and I have no control over that which is most important to me.  I'm not even remotely connected to this Operation InFutility.  I want at least to control my emotions.  Can I have that small corner of control?  Taking medication would mean surrendering.  If I survive this alone, it will be because I clawed my way out.  Not because I let medication modify my neurotransmitter chemistry.

It's funny, though.  I have no problem taking levothyroxine to replace my perpetually-out-to-lunch thyroid gland, or amlodipine and losartan to control my blood pressure, and while I detest it I (relatively) faithfully take my OCP.  I suppose the difference is that I know that without my levothyroxine I could end up in a myxedema coma, and if I don't take my antihypertensives I will end up with left ventricular hypertrophy and diastolic dysfunction and possibly hemorrhagic infarcts, and that estrogen in girls my age has bone and heart benefits.  I won't die without an SSRI.  I might just feel miserable.  I know exactly why I am miserable and I know that it can't get much worse.  Expectations of failure cannot disappoint.

Or am I just buying into the stigma of mental illness?  I do believe mental illness should be respected equally with physical illness.  It so often has worse consequences (at least among my patient population) and it is the result of chemical imbalances in the brain, not weakness of character.

 Could I argue it as a case of severity?  Were I suicidal or endangering patients I would likely be far more inclined to acquiesce.

Enough, though, about my conundrum.

I wish my mother and grandmother understood what it means to go through this.  The other day, Mama told me I am "too preoccupied" with infertility and babies, etc.  Would she tell a cancer patient he or she was too preoccupied with his illness?  Would she be surprised when that person was disappointed when four rounds of chemo failed?  (Yes, I understand COMPLETELY that IVF and chemo have very different stakes and that my life itself is not threatened, nor my physical health.  I am very grateful for this and I am NOT trying to compare the two!)  Would she tell a diabetic not to think about his or her glucose, and which foods he ought not eat, and whether he had foot sores?

This is what being infertile means:  It means watching all your friends have children, feeling envious, and feeling guilty for your jealousy.  It means wondering if your husband will leave you for someone who can have children.  It means trying to keep a mask when asked if you have children, and trying to find a neutral answer but wishing you could say "No, I don't and I am angry and hurt and upset about it!"  It means planning your career when you know you would only work part-time if you have children, but you have no idea if the children will even come.  It means explaining to your grandmother that no, adoption doesn't just happen overnight and there isn't an overflowing supply of pregnant women waiting to give up their babies, and it takes more than just finding a lawyer.  It means an intrinsic part of the life cycle is on hold.

It means that unlike your friends who say "when," you say "if" I have children.  A two-letter word makes all the difference.

Anyway, my in-laws are in town and I am supposed to wake them from their nap.  Happy  Christmas to all who will be celebrating, and a Happy and Healthy secular New Year to everyone!  May 2013 be a fertile one!

Vacation, all I ever wanted

That's right.  Since Monday afternoon I am on VACATION!!!  I don't have to be at the hospital for another two weeks.

How will I spend said vacation?  Good question!  I started by having my every-three-year cardiologist appointment.  I only have to go every three years since my heart is fine.  If you're wondering what to expect at a cardiologist appointment, they started with an EKG, then an echocardiogram (ultrasound of the heart), and then I saw my doctor.

My doctor is a sweetheart and an excellent clinician, and we got to read my echocardiogram together.  I have sinus bradycardia, but am asymptomatic (can wearing a scarf increase vagal tone?) and my EF and diastolic function are normal.  Translation: I have a slightly low heart rate but it doesn't bother me, and my heart's pumping and relaxing functions are normal.  I also have an adorable ventricular septal aneurysm, which means where the hole between the two bottom chambers of my heart filled closed itself into a really adorable shape.  It looks like a little heart!  Also (phew!) my aorta looks normal.

The other screening for girls with Turner's Syndrome is MRI/MRA of the thorax and abdomen to evaluate the aorta, the renal arteries, and the kidneys.  FYI not all of these tests can be done at once.  You should also expect to have an IV started because these tests require contrast.  The contrast is gadolinium, and when it is injected one should expect a flushed, warm feeling throughout the body.  It is such a curious sensation!  I have the abdominal studies completed and they're normal, so we are just waiting on the thoracic studies.

But not to worry, I do have plans for fun.  I am reading Charles Dickens (Bleak House, and it's wonderful!), with plans for Chitra Banerjee Divakaruni next.  Also I hope to do a little shopping.  And some writing.  And exercising!

And now, for the irony of the day: Jehova's Witnesses just came to the door and offered me a pamphlet about being a single parent.

In Which Our so-called Heroine is Confused. And also invites the input/mentoring of anyone in general medicine or infectious diseases.

Very confused.

I am about to be 50% done with my residency.  I don't know how time passed so quickly and so slowly.  I also don't know what I want to do after I finish.  That, dear readers, is the challenge.  I love general medicine.  It intimidates me a bit in that one must know everything.  But I like everything, and I l like the variability.  At the same time I am a meticulous, inefficient physician who fails ridiculously at multitasking.

My mentor/internist suggests I make lists of pros/cons for each option and talk to people in the different fields I am considering.  As usual, she is right.  IF YOU ARE OUT THERE AND YOU ARE A GENERAL INTERNIST OR AN INFECTIOUS DISEASE SPECIALIST, YOUR INPUT IS GREATLY APPRECIATED!!!

And then there is the other issue -- that I highly doubt I will ever be a mother, but if I were, I'd want to work part time.  Yet what point is there in crafting a career that allows me to work part-time when there is almost no chance of needing it?

I'm not even sure how to proceed with Operation Infutility.  Husband is not showing signs of wanting to move forward.  I, on the other hand, am not ready to give up.  I need children!  My dearest, best friend is still offering her ova and she is now married long enough that they should let her.  On the other hand, she doesn't have proven fertility.  But I think it's worth a try.  I could always find an anonymous donor at the same time.  It's just that Husband isn't currently interested in trying.  I don't understand.  I know there are lots of people out there who have meaningful, complete, happy lives without children.  But I am not one of them.  I dreamed about having babies from the time I was not much more than a baby myself.  I am happiest when I have a little one in my arms, when I get to nurture.  I am not ready to give up yet.  Because personally, if I can't have children I would rather overdose on all the potassium in my medicine cabinet, and all the antihypertensives, and all the NSAIDS.  Dramatic?  Yes.  But true.  I do not want to live a childless life.

Oh, one other little tidbit.  I got to care for a young woman with Turner's Syndrome the other day!  I am not alone, and I can make a positive impact on her.  I hope she choses to follow up in my clinic.

Have a good night, everyone, and Chag Chanukkah Sameach!

In Which IVF Fails. Again.

I've had quite the streak of luck.

1. Had to work a month at my least favorite hospital, with a bad attending, and a bad intern.

2. Was on call on my birthday.

3. As a birthday present, found out we were out of embryos.

4. Our fourth IVF cycle failed.  We did a two-embryo FET using an 8-cell and a 5-cell transfer.  I got the call today during a lecture on STEMIs (ie heart attacks).

At this point we have tried two different surrogates and two different ovum donors.  I don't know what our next step will be.  I wonder if it makes sense to continue.  Maybe I should just hope Husband will reconsider adoption?  My family keeps pushing us to continue IVF but my mentor/internist suggests cutting our losses and I think perhaps she's right.   But I don't want to make any decisions while I'm still emotional.

And emotional I am.  I feel angry and hurt and sad and hopeless and jealous.  I don't think I'll ever become a mother.  I don't believe anymore.  I want to be a mother more than anything in the entire world and I would give anything to make that happen.  But I wonder if I must accept the unacceptable.

I will eventually regroup.  For now, though, let the pity party continue: samosas and palak paneer for dinner, washed down with mango lassi.  A book-buying binge.  And a donation to charity.

Happy Thanksgiving...sort of.

In Which Our Heroine Emerges from two VERY LONG months

...only to be headed toward another busy one: cardiac care unit.  But at least I have done my two months as a senior resident leading a team and for the rest of the year only need to supervise myself.  Leading a team is challenging, especially when you constantly function with half a team because of peoples' days off and clinics.  It's disjointed and I wish there was a better system.  But nobody wants to read about how the ACGME mandated duty hours actually harm my education and patient care, so I will step down from my soapbox.

I don't have much of an update right now on operation In Futility.  I can tell you that this next cycle may be a major reflective point.  If it fails, we are again out of embryos.  I don't know what the next move should be.  Do we find a third egg donor and transfer to a different clinic?  Northwestern clearly hasn't brought us great success and I know there are some excellent clinics in Surrogate's state.  But is there a point?  Why do the same thing over and expect different results?

Except I don't know what other option I have.  Husband is still absolutely unwilling to adopt.  And I am unwilling to live without children.  My mentor/internist/person who tolerates my self-centered ridiculousness says that Husband will reconsider with time and that I should learn patience.  I know she's right that I need to learn patience.  But I'm not patient.  I have never been patient.  I wish I could be but I don't even know how to learn patience.

Dear readers: How does one learn patience?  Can it even be taught?  Personality traits are so difficult to change.

In Which Our Heroine Requests Advice or, When the White Coat get Heavy

Dear all,

I could use some advice.  Being a senior resident is TOUGH!  How does one manage the team?  And teach?  And supervise the interns while giving them autonomy?  And teach the medical students and make them think Internal Medicine is the BEST field EVER (because it IS!!!)  And not break down crying because of outside stressors?  And -- for the really ambitious -- get sufficient sleep?

I suppose that last can be answered by not blogging late at night.  So I will go to sleep now.

Goodnight all.  Moadim l'simcha for those celebrating Sukkoth.

Briefly, more updated

Another Yom Kippur has come and gone.  Another embryo transfer has come and failed.  I expected it to fail but still hoped it might be my rainbow baby.  After all, what could be more auspicious than a fresh transfer on Erev Rosh Hashanah?

Apparently, lots.  Surrogate's beta-hCG was 2.

We will transfer two frozen embryos in November.  At least, I hope we will have two.  There are currently four so I hope at least two survive the thaw.  If (or when?) we exhaust all the frozen embryos, we will consider switching fertility clinics.

It was a difficult day.  I don’t use my phone on Yom Kippur (Day of Atonement), but Surrogate texted me so it popped up on screen.  I forced myself to shul for the last 3.5 hours of prayer but struggled.  Less than twenty-four hours earlier I was dressed all in white, singing joyously to melodies we use only on the holiest day of the Jewish year.  But that night my eyes just ran over the prayers blankly and I could barely focus.  I was so sad and angry.  I believe without question in God, which only made it worse because I wanted to show myself that if you really believe you pray and you praise God no matter what.

Since then I am back at work, although I can't focus at all.  I just want to obsess and cry even though it changes nothing.  But knowing that intellectually doesn't stop the emotional me from wanting to scream, "STOP, world!  I am upset and I wish you would take notice."  Patients don't stop getting sick because I am upset.  Interns and med students don't stop requiring supervision and teaching.  So I guess I just have to pull myself up by my bootstraps.  My internist/mentor says just to plan for each day.  It makes sense.

One infertile day at a time.

:o(

Found out tonight that our transfer didn't take.  (Sorry I didn't mention we were even transferring -- didn't want to jinx it.)

I suppose on the bright side, no miscarriage this time.

We will try again, but I have stopped believing.

Shanah Tovah u'metukah! A good and sweet New Year!

Hello Dear Readers,

I promise to update you fully once I finish my ICU rotation.  In the meanwhile, I wish you all a happy and healthy (and fertile) 5773.

Take care,

Mim

Infertility Humor of the Day

Why attend a baby shower when you can throw yourself an infertility party?

Fun games can include:
1. egg retrieval: an ovary-shaped pinata stuffed with Cadbury eggs
2. fertilization: pin the sperm on the ovum
3. see-saw (low-budget) or, if you really want to splurge, rent Emotion: the larger-than-life roller-coaster (big budgets)
4. Guess the number of negative pregnancy tests in the jar -- win 5% off your next IVF cycle
5. Another guessing game:  Guess how much money the guest of honor/hostess has spent so far on unsuccessful babymaking.
6. Bingo, using the top phrases you should never say to an infertile.  Free space is "it'll happen when the time is right."
7. Instead of "What Time is It, Mr. Fox?" play "What Time is it, Dr. Reproductive Endocrinologist?"
8. Freeze (an embryo) tag!  (Warning: not everyone survives the thawing process.)

Serve sushi, wine, coffee, and anything else a pregnant woman can't eat.

In Which Our heroine should be happy about the latest update, but is instead terrified

This is a whiney, desperate-sounding post.  You have been warned.  But there is comic relief at the end.

If not excited I should at least be glad that things are moving forward.  Our donor's colonoscopy was normal, so; God-willing, we anticipate a mid-September transfer.  It will likely fall on or around Rosh Hashanah, the Jewish New Year.

I should be looking forward.  I neither expect nor want to be excited or optimistic.  But must I be terrified?  I keep envisioning losing another baby or babies.  And I don't know if I'm strong enough.  I know I come from a line of strong women.  But I don't even feel like a real girl.  (Cue the Pinocchio music.)  And I had some Very Black Days and some Very Black Thoughts during this process.  I never acted on them.  But what if...?

My mentor gave me her usual wise advice today:  I need to remember I'm not in control, and I need to remember that motherhood is not the only role that defines me, nor is it the be-all and end-all.  Of course she is right.  But I struggle to take her advice.  I want to be a mother more than anything else in the entire world.  And I don't think it's just wanting what I can't (ever?) have.  I want to be a mother because I want to be a mother.  I changed my sister's diapers when I was ten years old.  In high school, I read my little siblings bedtime stories and drove carpool.  At Shabbos dinner I spend more time with my baby cousins than with the grown-ups.  There was even a period where my little sister would call me "Mama" by mistake.

Give me children or I shall surely die!

(And yes, I know Jacob's reply.)

I know I mustn't think too many steps ahead.  And I know that I shouldn't focus on a timeline because I "won't be less of a mother just because it happens at forty-five instead of twenty-eight."  But honestly -- it doesn't feel that way.  I do feel like less of a mother because I play no role in the creation of this baby.  I know this is foolish.  If someone else were talking like this to me, I would tell her that motherhood is about raising a child, not making a baby.  And the idea of waiting another seventeen years sounds SO INCREDIBLY PAINFUL.  I know that the moment I hold a baby or babies in my arms, if I ever do, the hurt will be healed and it won't matter if I am a geriatric parent.

I can't seem to take even my own advice, huh?

Do childless women get babies in Heaven?

I just want to curl up and cry, and maybe talk more with my mentor, but I have already taken up so much of her time.

Okay, I should provide at least some comic relief.  Here: I asked a patient to provide a urine drug screen today.  He provided a cup of water.  Um, busted!

And how about other good news: Husband and I celebrate our third anniversary this weekend.  We have reservations at a very fancy restaurant, and I'll be wearing the dress from our American reception, and I even bought nail polish.  I haven't bought nail polish since I was thirteen.  It's ridiculously frivolous, and why would I want to be unable to do anything for two hours while the polish dried?  But I like being girly because stupid things like nail polish and makeup make me feel like a real girl.  You don't need chromosomes or hormones to do that.

I just wish I could get out of this self-centered rut.  I need to remember how lucky I am.  Even just to be alive is a gift.

I need to get a grip.

In Which Our Heroine is not yet sleepy

...so she's reading blogs and trying to calm herself to sleep.

The Baby Immersion weekend was actually a lovely time, no thanks to Delta for delaying both the departing and returning flights.  Seeing B and L, and S, and of course Baby A, was great.  I was very proud of myself for not breaking down even once.  It helped that B and L took a genuine interest in my struggles, and that B expressed their support for me in simple, heartfelt terms.

And I got to hold a baby  I held a sweet little two-month-old for what probably totals up to hours.  I haven't had that opportunity in so long...five years, I think.  In my arms I could pretend she was mine.  I sang to her in Yiddish and Hebrew.  I rocked her.  She fell asleep in my arms.  And I won't lie.  I pretended...that's allowed, isn't it?  It doesn't hurt anyone, and at least if I can't have real children I shouldn't be denied my dreams.

And I think increasingly about giving up.  I can't close this door yet.  I also know I will NEVER be truly happy without children of my (sort of) own, and I don't want to be happy without children because that would truly mean giving up.  But I just don't know how I can go through this again.  I nearly broke at least twice.  (Losing Baby B was easier because we still had Peanut.)  Can I venture there again?  Because I have no more hope.  This is a perfunctory exercise in futility that I am doing only because if I quit now I would always wonder if maybe the next cycle would be The One.  And honestly -- I don't want hope.  Hope hurts horribly.  Pessimism, on the other hand, is a protective blanket in which I can wrap myself.

People tell me this next cycle will work.  Why?  Why should it be any different?  Yes, I know the egg donor is a different young woman -- that is, IF she passes her colonoscopy on Wednesday.  With the luck I've had thus far...

I'm going to give a shout out to S for volunteering again, by the way.  I love you dearly.  I know I could count on you if I need to do so.

And I know my sister (who's ten years younger than I) will probably finish having children in another fifteen or twenty years, but would she be willing to make me one?  And is my late forties too late?

I am not giving up, but sometimes I don't know why.  This just feels like the definition of futile care.  And I HATE that I don't even bear the brunt of it!  Other people are taking medications, undergoing procedures, and paying more money than I can imagine, because of me and my flawed meiosis.  Why?

And the ridiculous part is, from an evolutionary standpoint, I shouldn't even exist.

I did have a sweet, wonderful, miraculous afternoon and I shouldn't neglect to record that.  I had a lovely morning clinic with one nutty patient and one very pleasant woman, and after noon conference ad a quick stop at Target, I picked up my little cousin and we made challah together.  While the dough rose we played hide and seek, and put on makeup, and ate marshmallows and chocolate chips.  And we both got covered with flour.  And yes, the challah tasted delicious.  Just like Shabbos should.

On Psychomotor Retardation

When I can't pick my feet up and I can't walk much faster than 3mph, I know the sadness is (literally) weighing heavily upon me.  I don't know how to escape it.  Walking usually helps but today it didn't.  I am tired.

Shadows

My mentor, as always, provided wise advice for my upcoming visit.  She wrote, "Consider it a pre med shadowing experience - in time you will get to be the MD.  Seems far off but it will eventually come..."

I know time often moves more quickly in retrospect.  Indeed, I can't believe med school is over and I'm not even an intern anymore.  I certainly can't believe my high school class will have its ten-year reunion this fall.  I just wish I could believe that "it" really will eventually come.  I don't believe anymore.  I believe in Hashem (God or literally The Name) and that He could give me children if He chose to do so.  I just don't see Him choosing.

The word "shadowing" started me thinking.  Infertility and shadows are so linked for me.  The dark shadows of depression.  The shadowy, just-hanging-on existence because NOTHING matters to me as much as having children.  Waiting in the shadows while my friends have their babies and even start having second babies.  The shadows of doubts that this will ever work.  Even ultrasounds are black and white and grey -- shadows.  And how about foreshadowing?  When I learned that we'd lost sweet Baby B I told -- my mentor, maybe? -- that as long as it was just one I could bear the loss.  Had I only known.

So yes, I suppose next weekend will be yet another shadowing experience.  Hopefully I will enjoy some part of it, and hopefully she is right that the Maternal Degree will eventually come.

This weekend my aunt is hosting her annual Spanish Night.  It was at this same dinner party last year that we announced our "good news."  A year can take sad turns.

Looking for advice from my infertile sisters

I'm venturing into the belly of the beast.  That's right,  my best friend S and I are flying to visit our other good friends B, L and their two-month-old baby A next weekend (27-29).  They are graciously hosting us in their home.

Prepare for infant immersion.

I love B and L.  We always have so much fun.  He's hilarious and she is just right for him (and funny herself).  They are foodies just like we are.  And S - well, she's S!  I miss her so much I can't wait to see her.

But B and L are parents now.  Their priority will be baby A.  It should be.  And I am glad they have their beautiful baby girl.  But how will I survive the weekend without breaking down?  S, B, and L know about my struggle and I'm sure they'll try to be sensitive, but still...and S has volunteered us to baby-sit while B and L enjoy a rare night out Saturday night the 28th. 

Dear readers, do you have any suggestions on how to cope with this trip?  I really want to see my friends but I am nervous about how I'll react.

Any and all advice appreciated.

Where is Joseph when you need a dream interpreted?

It was a sad evening.  I'm not sure what set me off, but it was.  I don't understand how sometimes I suddenly, without warning, feel like crying.

Maybe it's the dream from last night.

I dreamt I had triplets: a boy, a girl, and maybe another girl.  They were wrapped in receiving blankets and were beautiful.  But even in my dream, I knew they couldn't possibly be mine and I couldn't be happy even as they were given to me to hold.

Or maybe these were my three lost babies saying hello?

No, I haven't disappeared...

...I've just been on hiatus.  First my computer met Diet Vernors.  They found each other disagreeable company and the M and N keys refused to work, necessitating multiple trips to the Apple store.  Then, I was out of town two weekends in a row.  This having weekends off thing is neat -- do people get that every five days?  Wow!

Trip #1 was to Chicago.  This was not entirely a pleasure trip; Husband had to provide a sperm sample and get his bloodwork (again, despite having been tested multiple times and being faithful to me, just in case he somehow contracted HIV or HBV or HCV via the air).  Fortunately we got that (and the requisite fight) over with quickly.  I'd like to thank Delta Airlines for canceling our flight.  (Oh, wait -- no, I don't exactly thank them.)  At least Northwestern accommodated our slightly tardy arrival and we were done with the baby-related part of the trip by 1:30pm.  The nurse coordinator said they will split Husband's sample this time so that if/when this round fails, we don't need to come back but only to find a new egg donor.

I'm still not holding my breath.  I just hope that the miscarriage doesn't happen on my birthday.  Because it now looks like (IF donor's colonoscopy is ok) we are aiming for a September transfer.  Which would put mid-November in prime miscarriage territory.  Please, G-d, don't let that happen!

The rest of the weekend was a lot of fun.  We toured Navy Pier, saw a fencing tournament, walked all over the city, and overate.  The weather was lovely and it was nice just to spend some time together.  We also had fun embracing our nerdy science side at the museum of science and industry.  Of course, I just had to find my way to the room where the unborn babies are preserved to show different phases of development.  And yes, I found the 17wk3day baby.  Just a day older than Peanut was.

I did not cry.

We came back to Detroit, where I finished the last week of internship.  Then it was time for trip #2.  UP NORTH!  You only understand if you know where I live.  But that's okay.

And you will have to wait until tomorrow for details, because Husband is tired and wants to go to bed.

Good night and Shabbat Shalom, everyone!

Of impatience and A year ago tomorrow

No major updates today.  I just wish I could learn patience.  It is wrong to wish I could skip five months ahead until we get to cycle again.  I know that.  Life is too precious a gift.  Moreover, I know that once November hits I will be amazed at how quickly time passed.  But from the vantage point of mid-June, it seems an eternity!

How can I learn patience?  If I were a patient person this would be easier to bear.  But I am not patient. I have no clue how to become patient.  I can delay gratification, yes, but that's much easier to do when you know that after four years of medical school you will be a doctor, and after three years of residency you will be a chief resident or an attending.  Not that life is guaranteed, but assuming nothing goes drastically wrong, there is a set endpoint, and you work toward it, and then you get there.  With this baby-making there is no set endpoint and no guarantee of success.  In fact, if I calculated properly each cycle has a higher rate of failure than of a live baby/babies.  And you go on until you can't anymore.  And you have no control over the results.  The only thing you can do is stop trying.

I'm not stopping yet.  It's not that I believe I will ever be a mother -- I have no hope anymore -- but I don't think I can be more upset than I already am, so I might as well keep trying because it seems pathetic to give up after only three years.

Why am I here, anyway, when from an evolutionary standpoint I have no reason to exist?  I suppose I have a a purpose but I just don't know it.

 A year ago tomorrow I was in Chicago looking at an ultrasound of two tiny embryos and listening to their synchronized heartbeats.  It was the last time they were both alive.

The latest roadblock...but I'm sure not the last

Our donor's brother was found to be anemic and as part of the workup, a colonoscopy was done (yes, I know this is passive voice -- science mode) revealing numerous benign polyps.  I presume they are working him up for Peutz-Jeghers Syndrome.  He is having genetic testing done, and she herself is scheduled for a colonoscopy in August.  Meaning, even if the results are normal, we wouldn't likely transfer until late October or early November.  I no longer expect things to work out anyway.  We will see if we can get another ovum donor, just in case.

Either way, it now seems I am almost guaranteed not to have a baby in my twenties.  That would require a successful transfer by February, and I just don't believe anymore.

I'm thinking about adopting either a Tamagotchi or a pet rock.

And by the way -- Peutz-Jeghers Syndrome is NOT a premalignant condition, so why does it even matter?  Would someone tell my donor that she can't have children if she had the syndrome?  And it's autosomal dominant and her parents don't seem to have the phenotype, so isn't this more likely a spontaneous mutation?

More gallows humor: Anti-maternity photos

Jealous of your friends' maternity photos?  Sick of ogling their adorable baby bumps?  Why not take photographs of your own?  Here are some ideas for anti-maternity photos:

1. Arms out from your belly as if encircling a baby bump.  But you haven't got one, so frown.

2. Sit in a rocking chair, cradling the printout from the last ultrasound taken before you miscarried.  This one's a frown as well, and tears if you can manage.

3. If you sport a flat stomach, do a close-up flaunting your perfect body.  Grin and toss your hair for the camera.  Stick your tongue out at those pregnant women if you want.  No stretch marks for you!

4. A black-and-white or sepia shot of the empty room waiting for Baby Godot.  Sunlight focused on the cradle provides extra effect.

5. Multiple miscarriages?  Commemorate them artfully by laying the ultrasound printouts artfully in a bassinet.   Making "no" signs on each ultrasound in red permanent marker drives the message home even more.

6. Stand at the entrance to a maternity clothing store, wistfully looking in.

7. Sit on a park bench watching a new mother (ideally also younger than you) playing with her baby.  You are in soft focus, she is in sharp.

8. Close-up of your BFN.  Enough said.



And here are some other crafty ideas:

1. Glue a mirror into your empty OCP disks and voila -- you just made a compact!  Decorate with glitter and you've got a great party favor.  Especially fitting for handing out at baby showers.

2. Can't use prenatal vitamins yourself since your aorta is apparently porcelain-fragile?   Just don't need them because of your BFN?  Neither reason is an excuse not to by them.  Instead, use them to spell out "congratulations" on your friends' new baby cards!

3. Wondering how you will possibly afford your next IVF cycle, especially if you are using a surrogate?  Hold a raffle, with the prize being all the baby items you collected back when you naively thought you would quickly become a parent.

4.You can also raise money for your next treatment by holding a guessing game with a small buy-in, where friends and family guess when you will end up with a baby.  If you don't need the assistance funding the next cycle, or are taking a break, use the money to treat yourself at the bookstore/mall/ice cream store depending on your personality.  Or be nice, and use it to buy a gift for the person/people supporting you during this process.

5. Why are birth announcements the only announcements going around?  Must we discriminate against the other possible endings to embryo transfer?  Make BFN announcements (see photograph idea number 8) or miscarriage announcements.  You deserve to share your news, too!  Suggest that in lieu of baby gifts, coupons to the nearest soft-serve station are appreciated.



Why is it that as I approach our next round, I am increasingly bitterly sarcastic?

A little bit of gallows-humor...or perhaps I should consider this approach after all?

CITY, STATE – _______ University Internal Medicine resident M. and her husband I. were apprehended earlier today while attempting to kidnap two newborn girls from the _____ Women’s Health Hospital.

The couple, who are unable to conceive due to a chromosomal abnormality, have been exploring various options for family-building since December 2009.  While originally intending to pursue in-vitro fertilization using a donated ovum, the couple learned in June 2010 that health risks made carrying a pregnancy too dangerous for M.  “It wasn’t easy to accept that I’d never have the adorable baby belly and that our private issue would become public knowledge, but eventually I accepted what I could not change,” states the first-year resident planning to pursue a career in academic internal medicine.  She and her husband I. (a Master’s candidate also at _______ University) started the process to find a surrogate mother to carry the child.  

I. states, “It was just taking so long, and it isn’t even legal in our state so we would have to go to Chicago, and I just hate driving long distances.  So we came up with an alternative plan.”

"We also felt this would be more cost-effective," adds M.  "Surrogacy can total over one-hundred thousand dollars.  Our ski masks cost fifty dollars for the two of us, and we used a scissors from home to cut the Hugs tags."

Indeed, the couple went to their local Bavarian Village store and purchased two black ski masks.  Faces covered, they went to the hospital, which is part of the ________ Medical Center.   A security guard tried to bar the entrance but backed down when threatened with a stethoscope and a Queen Square reflex hammer.  M. then used her student identification card to gain access to the nursery.  Inside, she and I. blinded the on-duty nurses with specially-augmented Panoptic ophthalmoscope.  They then chose two newborn girls, cut off the infants’ Hugs tags, and exited the secure area.  They were apprehended when M. realized she had failed to perform the medicine reconciliation and stopped to fill out a form at the  closest nursing station.

The newborn infants were safely returned to their respective mothers, seventeen-year-old A and sixteen-year-old B.  Neither mothers nor babies were available for comment. 

Sometimes, I really do wonder if that might be the easiest way to get a baby.  It's just that I have a feeling they don't let you continue your residency if you go to jail.

In Which our heroine seeks advice

I am sad, bitter, and envious.  I admit this freely.  And now some friends are baking Baby #2, which doesn't make things any easier.

But why should I feel this way?  I have such goodness in my life and yet I can't appreciate it.  I have tried chasing away the negative emotions by listing the reasons I should be grateful.  I have forced myself to dance to peppy music.  I have banged out Beethoven on my piano in ways that would make him spin in his grave.

Nothing helps.  Does anyone have advice?  I wish I could move on to acceptance already.  I know I am missing out on life by feeling down and upset.  And I know that my attitude is the only part of this process under my control.  So why can't I learn to bear this with grace?

Struggling again...but trying to hold on to hope

I love medicine.  I love teaching medical students (on those rare occasions when I actually know something).  I am no good at either the medicine or the teaching, but I enjoy them.

It helps not a bit.  I sit in the radiology reading room to review a CT abdomen and a pelvic ultrasound series, but my mind is back in March 2010 when I was the one on the receiving end of the pelvic ultrasound, and the same Dr. J was reading, and they couldn't even find two streak ovaries.  Just one.  I remember the student ultrasound tech's sympathy, and how I tried to reassure her that this was ok, they had proved my uterus was normal, so this wasn't really bad news.

I couldn't have known that two months later a certain REI specialist would tell me my PERFECTLY NORMAL aorta is in terrible (yes, because 2-5% is such a high rate) danger of dissection if I become pregnant.

(By the way -- that same aorta has had no trouble pumping blood for a six-mile run.  Just saying.)

It was like this last time, too -- the sadness was a delayed reaction.  Again I walk on leaden legs, and my thoughts are 80% baby/infertility-related.

I should be looking forward.  Our new donor had a successful consult pending the send-out genetic tests which should be back in a week, and we are hoping for a transfer in late July or early August.  But I stopped expecting last August.  Why should this ever work?  My therapist told me this will eventually work out -- that I am motivated, and keep trying, so it will eventually work out.  If only.  It won't work.  The only future I see is one in which I continue to watch everyone else have children while I remain forever childless.  The only reason I am even willing to board the emotional roller-coaster again is that I won't accept this childless future.

My mentor/internist/person to whom I come crying far more than I ought tells me motherhood is great but not all that life has to offer, and that I shouldn't let it be the only reason I exist.  I'm a "wonderful human being with lots to offer."  If only that last were true.  I am unwonderful.  I do one thing well, and that is complain.  And what could I possibly do that would provide the same connection, with all its wonderful and pull-you-hair-out moments, as motherhood?

I feel sad and alone.  And the worst part is, I am not alone and I should be grateful for all the wonderful people and pets and things in my life.  Infertility isn't making me sad.  I am.

Told you I was unwonderful.

It has been a frustrating week.  I feel overwhelmed at work, both with the workload and with my utter lack of sufficient clinical skills and medical knowledge.  And then work has been sad.  I made two patients hospice this week, one of my favorite clinic patients almost certainly has hepatocellular carcinoma, and another of my patients has advanced cervical cancer -- which, incidentally, is now a PREVENTABLE DISEASE.  GET VACCINATED AGAINST HPV!

These patients are good people.  They are young.  They are parents, siblings, spouses.  And I had to tell them they have advanced cancer.

I wish I could tell them it would be all right.  They could take a magic pill and get better.  But they won't. And while I can be liberal with morphine, I cannot say that it won't hurt.  And it might hurt a lot.

But then, if I understood why bad things happened to good people, I would be the wise (wo)man on the mountain.

And yet -- and this is what I really don't get -- why do I still get so upset over my small problems?

Trying to think about what I am rather than what I am not

I am not a mother this Mother's Day.  And if Mama tells me she will be wishing me a happy mother's day next year, I may break down and cry because I doubt a baby will ever happen.

But maybe if I focus on what I am, I will feel one teensy bit better.

1. I am a physician.  I have the best job in the entire world.  I go to work each day to make people feel better and teach students the art and science of medicine.  I make crying patients smile.  Is that even a job?  A calling, really.
2. I am the winner of a Hopwood award.  I won't say which category or which year because I want to remain anonymous.  But dang, I won a HOPWOOD.  If you don't know, that is the same award Arthur Miller won during his time at the University of Michigan.
3. According to the in-training exam, I am in the top 5% of internal medicine first-year residents in the nation.  (It's clearly inaccurate, but...)
4. I am tough!  I said a last goodbye to my almost-son, got on a plane home, and spent the night admitting patients at the hospital.
5. I make the best matzah-ball soup and the best challah and one killer Tzvia cake.  Don't mess with me on Erev Shabbos.
6. I am witty.
7. I get along with my mother-in-law.  (Trust me.  This one deserves to be on this list.)
8. I can do peppy on three hours of sleep.
9. My eyelashes are so long that when I wear mascara, people think they're fake.
10. I can run for a code in heels and be first on the patient.

Mother's Day, Infertile-Style

Tomorrow is, of course, Mother's Day.  Also known as "Flaunt your fertility" day or "Happy working gonads day."

I am trying not to be bitter.  It isn't working well.  Had things gone as hoped, I would had a baby boy right now, or actually twins, and then another baby on the way.

But my arms are empty for another Mother's day.

I am trying to remember how lucky I am.  How many people must remember mothers who are gone this Mother's Day?  I can't even imagine how horrible and catastrophic it must be to lose one's mother.  I am so incredibly grateful to have my Mama and my Mama Phyll.  And I know the point of Mother's Day is to celebrate one's own mother, not to be upset about being excluded from the club.

But I will never compare stories of morning sickness.  I will never have war wounds from pregnancy, labor, and delivery.  I will stay silent as my friends come up with cute ideas for telling their husbands they are pregnant.  And *if* we ever even end up with a baby, or so close to delivery that we want to tell people (like, 39 weeks, perhaps?) I will receive quizzical looks instead of congratulations, as every is confused at my empty belly.  I will explain, and most people will understand, and ask more questions because they find it fascinating.  (We're doctors, remember?)

It is not fascinating.

It hurts.

It especially hurts when two people today wish me a Happy Mother's Day.  Ummm...thanks?  Are you bringing the  baby as a present?

I have however come up with some dark humor.

I would invite my family for brunch this year, and make eggs, but -- oh!  I don't have any!

(And yes.  You were supposed to laugh.)

It was a very long week returning to work.  I have the day off tomorrow, though, I don't have more to write now because I am exhausted from a very long week at the hospital and some needy patients.  Thank goodness I have a day off tomorrow!

Choose Your Own Adventure (even if it's only imaginary)

That's right, I have decided to Choose my Own Adventure.  I might not get what I want in real life.  But I can type it out to my heart's content.  And who knows?  I have thus far found some strange imitations of my writing in my life, so maybe...

The paperwork to secure and contract with the new egg donor will go smoothly, and Surrogate will also be willing to try again as soon as medically indicated.  The egg retrieval will be in late July.  All of the eggs will fertilize, and they will be grade A embryos.  They will implant the first two.  Either implantation will be 31 July, because that is my beloved Mama Phyll's birthday, or that will be the day of the beta-hCG.  And that beta-hCG will be positive.  Very positive.  And it will quadruple forty-eight hours later.  Because -- as we will discover at the six-week ultrasound -- the embryos both implanted and Surrogate is carrying twins.  And at the six-week ultrasound both embryos will measure six weeks.  And they will both have strong, perfect heartbeats.  And at eight weeks both embryos will measure eight weeks, and they will both have strong, perfect heartbeats.  And they will continue to grow, right on schedule.  They will be perfectly healthy.  And Surrogate will also be perfectly healthy.  She won't even have a day of morning sickness.  And somewhere around eighteen weeks, she will feel the babies kick.  They will continue to kick.  At the twenty-week anatomic scan both fetuses will be found perfectly healthy again.  They will continue to grow and develop and everything will be just as a pregnancy ought to be.  And at thirty-nine weeks or so,  husband and I will fly to Surrogate's state so that we don't miss a moment of our children's lives.  And then our children will be born on Mother's Day.  Surrogate will have a quick, painless-as-possible labor, and minimal blood loss, and feel ready to dance by the next morning.  The obstetrician will let me help catch the babies so that I am the first person to hold them, and Husband will cut the umbilical cord.  I will carry them over to the warming tent and will calculate their Apgar scores (10 and 10 at one and five minutes for both children) along with the pediatrician.  And I will not leave them for a nanosecond.  And I will kiss their beautiful, soft foreheads and checks and Husband and I will bless them with the traditional parental blessing, whether it is to be like Sarah, Rebecca, Rachel, and Leah (daughter version) or like Ephraim and Menashe (son version) and we will recite the She'chechiyanu.  And we will tell our babies how much we love them.  And they will be discharged at forty-eight hours of life after an uneventful course, no hyperbilirubinemia or anything.  And at one week, when we fly home, the entire plane will congratulate us on our sweet, beautiful babies.  And then we will have the biggest simcha my little city has ever known, whether its a zeved ha'bat and/or a bris.  And our little home will fill with well-wishers and there will be a table literally overflowing with sweets of every kind, from every country.  And the entire time, I will cry with happiness.

And maybe then it will stop hurting.

יזכור

יזכור: יום הזיכרון לחללי מערכות ישראל.

הערב התחיל יום הזיכרון, יום מוקדש לאלה שנפלו במלחמות ישראל או בפיעוים.  אני מציינת את יום זה לזכר מי שאינו כאן.  יותר מדי בנים ובניות ישראל אינם איתנו.  חובה עלינו לזכור אותם.

יזכור עם ישראל את בניו ובנותיו, הנאמנים ואמיצים,

חילי צבא הגנה לישראל,

וכל לוחמי המחתרות וחטיבות הלוחמים במערכות העם,

ואנשי קהילות המודיעין, הביטחון, המשטרה ושרות בתי הסוהר,

אשר חרפו נפשם במלחמה על תקומת ישראל,

וכל מי שנרצחו בארץ ומחוצה לה בידי מרצחים מארגוני הטרור.

יזכר ישראל ויתברך בזרעו ויאבל על זיו העלומים

וחמדת הגבורה וקדשת הרצון ומסירות הנפש

של הנספים מבערבה נכבדה.

יהיו חללי מערכות ישראל עטורי הנצחוןחתומים בל ישראל לדור ודור.

Touching quotes about miscarriage

I didn't write these, and they don't make it hurt less.  But at least they are sweet.

I didn’t get to feel you kick, or look into your eyes.
I didn’t hold you in my arms, or hear your little cry.
I didn’t get to see your smile, or even know your name.
But, you’ll always be my baby and I love you just the same


"There is no foot so small that it cannot leave an imprint on this world or our hearts"


"Strength isn't about how much you can handle before you break.  It's about how much you can handle after you break."


and because Mother's Day is approaching:

ה נתן, ה לקח, יהי שם ה מבורך God giveth, God taketh away, blessed be God's name AGAIN

I didn't post any updates that were Operation Baby-related after the beta-hCG testing.  I didn't want to put an Evil Eye on things.  But it seems that doesn't matter.

Our surrogate did get pregnant with one little Sweetpea who made it to five weeks, four days.  But at the ultrasound there was no heartbeat and the baby was too small, and a repeat also showed no heartbeat and no growth.  Surrogate is scheduled for a D&C on Tuesday morning.

I got the bad news while at dinner with Husband and our best friends in Israel, who are seven months pregnant.  When we got back to the hotel, the television did me a favor and broadcasted such perfect programs as "Father of the Bride: Part Two" and the episode of Ramzor where Tali discovers she is pregnant.

We will try again as soon as we find a new egg donor.  Husband remains unwilling to consider adoption and while I disagree with that decision, I will support it for now since surrogacy is still an option.

Am I just not meant to be a mama?  And if not, what can I possibly  do that would be even half a meaningful?  I want to be a mama so much that I would give up medicine if they were mutually exclusive.  I am trying to count my blessings and keep reminding myself of the line from Job "God giveth, God taketh away, blessed be God's name" but it is challenging to really mean it.  At least this time the baby is already dead, and I didn't see pictures that looked like more than a sac, and Sweetpea was only five weeks and four days along and we told only the very closest people.  And maybe if you really really want children but don't get them you get to be a mama in Heaven eventually.

That's the sad update of the day.  I hope, dear readers, that your weekend goes better than mine.

And a question:  Is it wrong to cave in to the temptation to cancel the workshop I am supposed to lead at a conference next weekend?

Israel: Land of the Fertile

We are having a wonderful time here.  This place is home in a way no other is.  And how better to celebrate Passover than in the Jewish homeland?  Granted, I prefer my family's seder.  We sing more, we enjoy more, and we don't rush through it as fast as possible.  But this is the only holiday I have celebrated with Husband's family in the five years we have known each other, so he is entitled.

Besides matzah, we have managed to:
1. visit a world flower exhibition -- crowded but beautiful!
2. "hike" -- this requires quotation marks because our gang has changed a bit.  Y and A had their twelve-month old, B, and the participated with a walkie-talkie from their car.  E is seven and and a half months along, and not particularly mobile either.  So actual hiking amounted to about fifteen, maybe twenty minutes maximum followed by sitting and eating, and then moving to a restaurant to continue sitting and eating.  Yes, Israelis like to eat.  (And tell me to eat more.)
3. Family time: Savta, niece and nephew, lots of fun and lots of nudging me to eat.  A yiddishe bubby, after all.
4. Shopping at the mall.  I found the lip gloss  I wore at my wedding and yes, it is now coming home with me.  I like makeup.  It is absolutely feminine but does not require chromosomes, hormones, or ovaries.  I am just like any other girl.

My main question, however -- how did this place get so fertile!?  I have never seen so many strollers, so many pregnant women, and so many babies.  Is is something in the water?

Resisting sleep and counting down the days until yontif

Resistance is futile, say the Borg of Star Trek.

I beg to differ.  I should have been asleep hours ago.  Instead I went shopping with my sister, overate, and read another chapter of the book I borrowed from the library.  It's called Mazel, by Rebecca Goldstein, and is very interesting thus far.  I like the stylistic quirks and the heimish quality.

Heimish, by the way, basically means "homey."  I never lived in a shtetl and I have never even been to Eastern Europe.  But I grew up at my Alte Bubby's feet with the stories of Antonifka and Rovna, with tea with sugar and lemon.  I could almost taste the warm milk fresh from the cow, and I feared the pogroms as if I too had hidden in the sewers.  And when I was five years old and terrified out of my mind that the Nazis were going to snatch me from my bed?  Only my beloved Alte Bubby, zichrona li'vracha (may her memory be a blessing), could console me.  So yes, I read this book and think about her and oh, do I miss her.  She was so beautiful -- regal like a queen until the very end.  She kept her hair a honey-gold color and she polished her nails a deep mauve.  And I can still smell the Ponds lotion she rubbed on her hands.  Her fingers were thick.  She was shtark, mine baleibte Bubby.  Those were not idle hands.  There was always a roast in the oven, or a lokshen kugel (ours was a pareve recipe), and on the stove a chicken soup of course.  And for dessert she would make the special comish cookies.

...and now we have entered the final countdown.  That's right!  ONE MORE NIGHT of my favorite hospital is all that stands between me and Israel.  I can almost taste the falafel.  Or the sambusek.  Or the -- goodness, why is all the good food thousands of miles away?  But mostly I am excited to be away from the hospital.  I love helping patients but I just feel so incompetent, and I hate that feeling.  I wish I could actually be the doctor I want to be.  So it will be nice to have a break from being public idiot #1.

Anyway, that's it for now.  Will post more when I am actually coherent.

In Which Our Heroine isn't much of a heroine. She's just tired.

I haven't much to say except that I am tired.  I could sleep for days on end and not feel refreshed, I think.  Vacation can't come soon enough.

But why am I so bone-weary?  I work, but not the way residents used to.  (We won't get into how I feel the new duty-hour restrictions ruin my education.)  Yes, I am working nights currently, and thus switching between nocturnal and diurnal lifestyles very few days.  But I have frequent days off, and yet I am still so tired!

It's frustrating.  I want to feel refreshed and eager to meet the day. But what I actually crave is to curl up in bed and sleep.  I feel emotionally drained as well.  That's multifactorial -- part of the mixed blessing of caring for my patients, and partly related to Operation Baby with its cycle of pain, worry, despair, and hope.

Yet sleep is no escape from infertility.  Last night I dreamt that they told me our new surrogate couldn't be the surrogate because her mother had just ruptured a cerebral aneurysm and so had her brother so she needed time to her family.  Of course Mama Phyll and Mama reinterpreted the dreams positively for me.  But to me it means I am clearly stressed.

And what if medicine isn't right for me?  I know so much less than my colleagues and feel too exhausted to improve myself through reading.  I get incredibly anxious every time I have to see a new patient.  Clinic doubles my systolic blood pressure.  I am generally more stressed when I "do" medicine than when I "do" books.

What if I am supposed to be a professor of literature?

I know I was influenced by Mama.  It's not news that I wanted to be like her and that I wanted to please her.  But I made a conscious decision to pursue medicine even knowing this.  I chose medicine to help people.  Literature is wonderful, and I am happiest and most comfortable with my head in a book, but it doesn't help people in the same way.

So where does this leave me?  In whom do I confide?  Do I even confide in anyone?  I suppose as a "married woman" I should be confiding in my husband.  But he thinks he works far harder than I, and he is completely unsympathetic.  (Plus he doesn't understand, as nobody can who hasn't been a resident.)  I can't confide in Mama because she can't imagine anything better than medicine.  She doesn't have an unenthusiastic cell in her body.

So we will see.  One day at a time, I guess.  And residency is finite.

I just hope I want to be a doctor at the end.

Brief explanation

If you are reading this blog (and in that case -- don't you have something better to do?  Something real to read?) you obviously know we are in the waiting game.  Unfortunately, we are also of the kinehora, tfu tfu tfu, hamsa hamas hamsa Very Superstitious persuasion.  Meaning, if, be'ezrat Hashem, things go well, I can't write about it.  Apologies in advance.  You are welcome to apply deductive reasoning, however.

But no results yet.  So Schroedinger's Surrogate is, according to quantum mechanics, both pregnant and not pregnant at this moment.  Or perhaps she is carrying a cat?

This is your brain on infertility. And a worrisome update.

Perhaps the most frustrating and debilitating aspect of infertility and loss is the inability to focus on anything else.  My body goes to to hospital, interviews and examines patients, answers questions right or wrong for the attending.  But my head and my heart are consumed, and with all my mental and emotional energy devoted to the babies I can't have, there is nothing left.  I barely read about my patients.  I miss important parts of their assessments and plan.  I know I am not the physician my patients depend on me to be.  Certainly part of this stems from being an inept intern.  But I think if I could learn not to let infertility take over, I would at least do better than I am now.

But how?

I am praying that we don't end up back at Square One.  It turns out that two of the four frozen embryos didn't survive, so if this FET fails...game over and player loses.  I am preparing for the worst and have already renewed access to ovum donor profiles.  I'm hoping to convince Husband that we should consider adoption, but am not optimistic.  The surrogate can cycle again almost immediately -- checked with Northwestern -- so the rate-limiting step will be finding a donor.  If only my sister were twenty-one!  They won't let her at eighteen, I don't think.  And Husband will be stuck repeating his entire workup.

Maybe this will be a moot point and I will find out good news.  Mama is convinced that everything will go perfectly and keeps telling me I am too much of a pessimist.  I am simply an optimist with experience.  And the experience of being forced to agree to termination while watching my baby move around on ultrasound, and listening to its heart beat is one I NEVER want to repeat.

So yes, I have a contingency plan which (for irony's sake) I am calling Plan B.  First step: supraphysiologic doses of frosting or ice cream.  Second step: spending large sums at the bookstore.  Third step: Plead with Husband to consider adoption.  Fourth step: Find some way to survive two weeks in Israel, where our best Israeli friends are expecting and everyone else already has babies.  That part is still a work in progress.  Would it be rude to seclude myself in our room re-reading Jane Austen the entire time?

Then, of course, there is the possibility of success.  I don't even know what I would do in that case.

In lieu of baking a baby -- some other options

Just because one can't bake a baby doesn't mean one can't bake!  They are called hamentaschen or אוזני המן but I just like to call them "delicious!"  We bake them to celebrate the holiday of Purim.  Added plus: both the "oven" and the "eggs" are much easier to procure and much cheaper than surrogancy.  (Recipe to follow when I have a chance to translate it into English.)



So many cookies!





Filled with stawberry preserves...






...and Nutella +/- coconut.  Yum!



...lemon curd...



Semolina cake, similar to a basbusa



Some advantages of being unable to carry a child about which you might not have thought

Most people can list some "advantages" of being forced to outsource pregnancy: no weight gain, no stretch marks, no flabby belly, no morning sickness, no heartburn, no caffeine or alcohol restrictions, and no labor.

But why focus on the obvious?  There are so many other advantages and so many things we CAN do!
 - We can empty Kitty's letterbox -- no need to worry about toxoplasmosis.
 - We can pinpoint exactly the moment of conception to forever embarrass our children.
 - nobody can ever say our future children weren't wanted.
 - We can deliver the ultimate guilt trip: "Before you were even born you were so expensive we could have travelled to and from Israel 54 times."  And yes, I am talking about round-trip tickets for two.
 - I am spending an exorbitant sum trying to make a baby, but I don't have to purchase prenatal vitamins!
 - Instead of prenatal vitamins, I got to continue taking raimpril and now losartan to treat my hypertension.  if I were pregnant, I'd need to take labetalol instead, which is a) less convenient because it requires BID or TID dosing and b)lacks benefits unique to ACEis and ARBs, such as renoprotection.  We wouldn't want a mommy on dialysis!
 - If things work out one day, I will get to show my newborn(s) off to an entire airport and a plane of lucky passengers.
 - In the meantime, I get to obsess on a daily basis about my loss and my infertility.  Anybody can do internship in a normal emotional state.  Only the truly tough can do it with 90% of her heart and her brain elsewhere.

In Which Our Sorry Excuse for a Heroine is Frustrated.

I think the most frustrating aspect of infertility w gestational surrogacy and egg donation is my absolute lack of any control and of any participation in the baby-making process.  I don't even feel like the embryos-on-ice sitting snugly at Northwestern Hospital are mine.  They are more related to Husband than to me, after all.  What did I do but fill out paperwork?

And now the nurse coordinator advises against Surrogate taking a home pregnancy test .  Honestly!  At least could I control how I learn about the results of this cycle?   Is even this forbidden me?  Did it occur to the nurse coordinator that I don't want to find out from her on the phone -- her with her always cheerful voice, which if we don't end up with a pregnancy is going to cut like a scalpel?  But then, no matter what I will find out on the phone.  I don't even get to do the test myself.  And this frustrates me so much, the complete removal from the baby making process.  I feel like a fake girl even more than I already do as a Turner's girl.

I wish rereading my affirmations would help...

Sadness comes in waves

Its odd -- I can be suddenly overjoyed at the fact that Abraham Verghese replied to an email, or that I made my mentor proud, or that a patient is improved because I treated him/her appropriately.

But equally suddenly I can enter a deep despair.  A good friend shares a baby-bump picture on Facebook -- day is gloomy.  Find out another friend is pregnant -- bring on the choco-therapy.

Why can't I just be content with what I've got?

At least I had a really nice conversation with New B today at my lovely Auntie's birthday.  We ended up talking about Operation Baby a bit, and she was so incredibly understanding.  I haven't met many fertile women who so easily understand.  She practically voiced my every emotion.  But the most comforting part was that a) she understood how painful this can be and b) she told me that EVERY one of her friends who wanted children ended up having them, one way or another.

I must hang on to that.  If I truly want children, I can eventually make it happen.  I hope?  I sometimes think about the possibility of never having children.  That is what Mama doesn't understand -- there is a very real possibility of never having children.

What do I do then?  What is my purpose?  What is my legacy?

When do we plan on having children? And a question for the intended-parent and surrogate community

The latest answer to when we plan on having children:  "We mistakenly chose to name our firstborn Godot, so it's going to be a long wait."

One of these day's I'll parody Godot again, infertility-style.  But it's been a while since I read Beckett and I didn't particularly enjoy him, so I don't remember quite enough for today.

And a question for the intended-parent community:  Is one expected to be present at the embryo transfer?  I'm exhausted, and Husband and I always fight when we go to Chicago, and I work Friday night through into Saturday morning.  And going alone when Surrogate is going with her husband seems awkward.  Plus, flights are expensive.

On the other hand, is there an etiquette to this?  Am I expected to go?  Motherhood involves plenty of inconveniences and so does pregnancy, so why should I complain?  Also, Surrogate seems really to want us present.  And I feel less as if I'm taking advantage of her if I must inconvenience myself a bit too.

Anybody out there been in this position?  Advice appreciated!

There must be something positive about the infertility of Turner's Syndrome

Okay, so I managed to think of something.  If I don't want to have a period, I don't have to.  I can skip my OCP and go without a period, or shift the timing of my period.  (If you can call it a period.  Technically isn't it more of a withdrawal bleed, nothing more than chemically-induced shedding of the lining?)  The cost is more hot flushes than I can count, but at least for once, I can be in control of my body.  My body prevented me from becoming a professional ballerina and it has prevented me from becoming a mother.  At least I deserve the option of controlling this one small thing.

I know it's silly, but taking the OCP bothers me sometimes.  I feel like a fake, like I'm just imitating what everyone else does naturally.  It's ridiculous.  I have no problem taking levothyroxine to compensate for Hashimoto's thyroiditis.  I have no problem taking losartan to treat my hypertension.  But why must I take birth control pills for my hormone replacement, when more than anything else in the world I want a baby?

Again, trying to be positive.  Let's see with what we can come up.

1. Something I never realized bothered me until recently was that, from an evolutionary standpoint, I have no reason to exist.  BUT -- when God created the universe, He didn't make any mistakes, right?  So I must have a purpose.  I have a reason to be here.

2. Pursuing surrogacy is meaningful in ways a regular pregnancy can never be.  Other couples celebrate only a pregnancy and the birth of a baby.  We celebrate we we find an egg donor, when we find a surrogate, when we sign a contract, when they implant the embryos, we we find out we are pregnant, and at the birth of a baby.  And if we celebrate so many times before a baby is even created, how much greater can our joy be when we eventually get a baby or babies.

3. There are so many people cheering in my corner.

4. If this many people tell me I am maternal, maybe I am, and if so -- there must be a reason.

5. Think of the guilt trips if I even have children -- "You cost more than our house before you were even born!"

...and here we go again.

Time to ride another emotional roller coaster!  We signed our contract with N, the new potential surrogate.  She will start medication on Sunday.  Keep your fingers crossed for a successful FET (frozen embryo transfer) next month!

Affirmations

If I can only believe in and do the following...

1. I will emerge from this journey a stronger person.  The worst-case scenario happened and I'm still standing.  If I survived that, I can survive anything.
2. I will bear with grace the disappointments because the only thing I can control is my attitude.
3. My worth is not connected to my ability to have children.  Even if I sometimes feel so.
4. I am a girl.  Even if I have an isochromosome, and no functional ovarian tissue, and hormones that come from a pharmacy, and can't be pregnant, and am not a mother.  I am as much a girl as anyone else.
5. I will emerge from this journey a more patient person.
6. I will learn to count my blessings.  "Who is rich?  He who is happy with his portion."
7. I will look forward.  The past cannot be changed.  "Though nothing can bring back the hour, of splendor in the grass, of beauty in the flower, we will grieve not, rather find strength in what was left behind."  Or as my beloved great-grandmother (of blessed memory) said, "Life is for the living."  Or as the cast of Rent sings, "Forget regret, or life is yours to miss."
8. I will turn this into an opportunity to learn better coping skills.
9. I will smile at least once every day.  As long as you can smile, all is not lost.
10. I will learn to cede control because sometimes, there really is nothing you  can do.
11. I WILL be a mother one day.  Even if it only in Heaven.