Interesting article from Ha'aretz מאמר מעניין מעיתון "הארץ"

קראתי את המאמר הזה וחשבתי שאולי גם אתן תרצו לקרא.  ניסיתי להעתיק את כולו אך לא הצלחתי, אז היה יש את הגישה לאתר.  בקיצור, זה לא הכי אופטימי, אבל צריכים לקחת בחששבון שמשפיעה גם כמות הנשים שעוברות עשרות מחזורי טיפול.  מה שכן, אהבתי ללמוד שנשים בארץ (לפחות אלה שמבותחות) זוכות לטיפולים מכוסות, ואפילו הרפייה חוץ גופנית, ואפילו עד ילד שני!  חבל שלא עליתי ארצה, הה?  (זאת אומרת -- עדיין לא עליתי...תמיד יש תקווה, נכון?)

http://www.haaretz.co.il/news/health/research/1.1917264

For the English - speaking among you, the above article is likely translated if you are interested.  Briefly, it discusses the dropping success rates of fertility treatments in parts of Israel, but acknowledges that this may be due partly to the women who undergo as many as twenty cycles of treatments, and thus affect the averages.  The cool thing to learn was that many women in Israel have even IVF covered by insurance, even up to the second child!

Anyway, have a good night, dear readers!

Sign on the dotted line...

Our donor has agreed to proceed, so we just need to prepare the paperwork.  The nurse coordinator says we should expect a May transfer, give or take.  (It's far too early to know exactly when people will cycle.)  I am too tired to write more now, but will try to update later this week.

Good night everyone!

Update du jour...

...is that's I'm waiting for an update.  Husband and I chose an anonymous donor.  (Thanks to you, you-know-who, for your thoughtful discussion of the risks and benefits of known vs anonymous donors!)  Our reasoning eventually came to the fact that S, my best friend, has too crazy a schedule because of her residency and too high a stress level for it to be fair to ask her right now; also, she doesn't have proven fertility, which is the one thing the REI specialist suggested we could change.  So we found a lovely young woman with two children and we're waiting to hear back.

I'm trying to occupy my time as best I can.   I've gotten back to exercising, though to solidify it as a habit will take several more weeks.  I'm reading (Charles Dickens and Chitra Banerjee Divakaruni) and studying Infectious Diseases.  (When your Daddy is the attending, you especially want to look smart!)  I still get sad but it is a little better this month, perhaps because of ID being a fun field and my fellows being fun girls.  Sometimes, though, it's hard.  I called one of my good friends from high school.  She's pregnant, and I have a hard time figuring out about what to talk.  I don't want her to think that she's nothing more than her uterus, but I don't want her to think I'm avoiding the (growing) elephant in the room.  I will say I did a very good job of being excited for her for a solid hour and a half on the phone when she called to tell me her good news.  It's also hard when someone gets excited for me to proceed forward.  I ended up telling the ID fellow about needing a surrogate.  She's asked some questions, which is really sweet.  But she doesn't realize that when it's round 5, there is nothing exciting about it anymore.  You sigh, and steel yourself for disappointment, and try to force yourself not to be excited.  The two-week wait actually becomes easier each time, because you know it'll be a negative beta-hCG so why rush and why be anxious?

The scary part is, I find myself becoming hopeful.  That, dear readers, is not good.  Hope hurts when it's betrayed.  I worry that this cycle -- which isn't even a go yet since we still need to hear from the donor -- will fail and I will fall apart.

Yet this hope isn't like the anxiety and hope I felt with cycle #1.  It's more...prophetic in nature.  Of course in the Torah Miriam was a prophetess even from the young age where (according to midrash) she told her father Amram that he should not divorce her mother Yocheved.  But honestly, sometimes I have intuitions which are surprisingly accurate.  (Don't worry, psychiatrists -- I will provide an address to which you may send the antipsychotics at the end.)  With the first cycle, I didn't expect to lose baby B, but once we did, I had numerous visions of losing baby A.  I saw myself telling my internist/mentor and telling my batch-mates in residency.  With our second cycle, I looked at names for the brief moment of happiness, yes, but I never truly latched on to the idea that the transfer took.  Even before we knew there was no heartbeat, I felt the sadness and emptiness and had no expectation of a baby.  With our fourth and fifth transfer, I expected failure.  And now?  I don't have quite that same expectation of failure.  I had such clear visions of losing baby A.  It wasn't that I exactly thought it would happen.  It's more that I kept seeing these stories in my head where we lost the baby, me telling those close to me that we had lost the baby...and with the second cycle I had a dream too that we lost the baby before we even had the fatal fetal (haha) ultrasound.  Now I have had many pictures in my head of telling my attending that I might not finish out the rotation because (surprise) we are thirty-four weeks.  In these visions I haven't told anyone except close family and my best friends because I don't want to tell anyone until I hold a healthy baby or babies in my arms.  But I am not righteous like Miriam and certainly I don't merit prophecy, and anyway, if I did, I would hope Hashem gave my insight into something more helpful to other people that just knowing the outcome of my IVF attempts.

At any rate, I do wish that this next cycle might succeed, but I don't want to hope.  I am so afraid of hope.

I've Gotta Crow

In a rare turn of events, Mama, Daddy, and I are all caring for the same patient.  I can't provide details out of respect for my patient's privacy.  But I can say that I out-diagnosed and out-historied my Mama.  (rib fracture and pulmonary history)  I'm sure it was just a stroke of luck.  But I'm still going to brag.

PS: In Which our heroine hosts the lamest party ever

I invited all the girls from my residency class over for dessert Saturday afternoon.  There are eight or ten of us.

One girl came.

Plus side:  My Infectious Disease team enjoyed a whole lotta sweets today!

Now boarding: emotional roller-coaster #5

That's right, dear readers, Husband has agreed to try again.  We have to decide whether to accept my best friend's offer to be our egg donor or to choose another anonymous donor, and we have no cycle dates in place yet.  It will likely be a few months.  Surrogate N is thrilled.

I'm on the other hand, am worried and lonely.  Will I have the strength to bear another failed cycle?  I'm so close to breaking.  If we run out of eggs again, if Husband still refuses to adopt, I don't know what I would do.  Childless is an option for some people.  It's not for me.  I would die.  Except suicide is a sin, and so in all truth I would just live a very very sad life.  Perhaps it hurts less with time?

The loneliness hurts too.  Mama thinks I am ridiculously preoccupied, and Mama Phyll doesn't understand how one can pour one's entire heart into a cycle and be so devastated when it fails.  When your mother and grandmother don't understand, who will?  Even my other go-to person has been trying to convince me not to make this my entire reason for existence and instead to focus on other things.  She means well, but sometimes I wonder if even she doesn't understand.  After all, this isn't as if I want a new toy or a new book.  I want a child.  I need a child.  What else could possibly be as important for a girl who wanted to be a mama from the time she was three years old?

The other aspect of isolation is how my circle of non-pregnant or parent friends dwindles.  Every time someone makes an announcement, it's another person whose life is about to change forever in a direction where I can't follow.  I am left watching from the sidelines.  And while I have -- for the most part -- accepted that I will never be pregnant, when someone starts talking about her pregnancy all I can think about is how I will never experience that.  And yes, I understand it's not nine months of bliss.  But it's an experience most women share, the quintessential female experience, and I won't know what it's like.  I hate missing out.

But for now, this sad puppy is going to bed.  Busy day of Infectious Disease consults tomorrow with my very brilliant Daddy as the attending!

Liebster Blog Challenge, part two

I never posted the eleven random things about me.  Here they are:

1. When I was little, I thought the Troll Bridge at family camp really did have a troll living underneath it, and only Art Man could save you.  Even in college I felt a twinge of apprehension crossing it.

2.  I love thin-crust pizza.

3. I memorized the first 100 digits of pi in sixth grade because math class was boring.  Yes, I still know them.

4. I have never been drunk, or even had more than one glass of alcohol in a sitting.

5. I still feel like I am playing house even though Husband and I are married over three years.

6. I have dreamt in Hebrew, but only on very rare occasions, and usually there is a bomb and I wake up just before exploding into bits.  I have never dreamed in Yiddish.

7. When I was a child I had terrible nightmares on a regular basis, and it reached the point where I was terrified of falling asleep.  That part was solved by chronic sleep deprivation.

8. I don't like ice in my water.  It's too cold and it also makes my hands Reyanad  (ie they vasospasm)

9. I also don't like pop or soda or whatever you care to call it.  Rarely I drink diet ginger ale.

10. I love all desserts, but in general, the sweeter, the better.  Knafe from Shafiq makes my mouth water.  I also go head-over-heals for ooey-gooey underdone brownies.

11. My favorite ice cream flavor is Cake Batter from Coldstone.

January is named after Janus, the two-faced god of classical mythology.  The idea, obviously, is that the start of a new year entails looking both forward and reflecting on the year which passed.  I can't say 2012 was happy.  A miscarriage, two failed cycles, and not only are we out of embryos but Husband wants to take a break -- for who knows how long?

It isn't that 2012 was without anything positive.  And all I have to do is enter the hospital each day to feel fortunate.

But I felt so very sad on New Year's.  I love New Year's Eve.  It's when we all gather for a huge party at Mama Phyll's and it's freilach and fun and not fancy but just a nice evening with tons of family and friends.  Part of it was probably the strain of hosting my in-laws for the previous week, the fatigue of working a full day of Infectious Disease consults, and not even having time to shower before heading over to the party.  Whatever the cause, I just wandered through the party feeling lost.  I don't fit in with my sister or my little cousins.  My sister is a college freshman, and my cousins are young adults but single and not settling down right now.  I don't fit in with my parents' generation or my grandparents'.  I love my family more than life itself, but at the metaphorical dinner party, I have outgrown the kids' table and haven't quite made it to the grown-up table.  The only place I don't feel lost is with my baby cousins.  With little children you don't have to be anybody.  You just have to be honest and silly and imaginative.  And so the best moments of New Year's Eve were with my little cousin, S.  She is five years old and was wearing a white party dress with silver beading and white earrings.  I stole precious moments tossing her up in the air while her laughter melted my heart, and then, one precious glowing ember, at about 11:00pm when I found her sitting on the stairs watching "Brave" on the iPad because she was tired, and she snuggled against me and nearly fell asleep with her head on my shoulder and I could pretend.  I am lucky.  My little cousin is a warm child with a cuddly personality, and loves me to throw her in the air, or make her into a package to deliver to Mama Phyll or Auntie Diane.  But I have read James Barrie.  All children, except one, grow up.  How long before she's too heavy to play these games?  I am probably lifting at least a third of my weight already and though she helps, it strains my back.  How long before she loses interest?  She fills a void.

So now, after a vacation which was anything but restful (thank you, Mother-in-Law!) I am back at work, on the Infectious Disease service.  I am already exhausted and behind on my reading, but at least it's ID.  I know my ID.  I can Gram stain with my eyes shut.  I love detailed histories and physicals.  I like treatable illnesses and I like the cerebral aspect.  I read Mandell.  I like the meticulous attention to detail, or as Ghosh would say in Cutting for Stone, "constant vigilance!"  The fellows think I am on their level.  I am good at so few things.  It helps to have something I can claim.

Okay, so I want to brag for a moment.  Every internal medicine resident in the US took an in-training exam in mid-October.  It's a full-day multiple-choice exam testing all aspects of internal medicine.

I scored in the 97th percentile nationally.

That, dear readers, is something infertility can never take away!

So why is it Mama has decided I should do Rheumatology for the lifestyle?  I hate the musculoskeletal exam.  I hate the side effects Prednisone gives my patients.  And I don't want to spend my life taking care of fibromyalgia.  I actually like general medicine and infectious diseases.  And if God doesn't see fit to bless me with children, the only choice I see for me is to let work consume me.  Why do I need a lifestyle if I don't have children to enjoy?  So I can sit home and mourn that which never was?  So I can get a manicure and go shopping and do yoga?  Sometimes I just want to be numb.  And at least when I work twelve hours a day, I come home too tired to think much about the only thing I really want in life.