Thursday, December 17, 2015

Welcome to Denver...whose population at this time does NOT include Mim or A

Dear readers,

I intended to greet you all from Denver.  This would have been the first time I actually attended an embryo transfer.

Apparently the travel safety authority felt otherwise.  I have that dangerous, 104-pound baby-toting mama look.  Clearly I am force with which to reckoned and a menace to society.  When provoked I could poor milk on people's heads, or magnetic fish.  I could even bore them to death by reading Goodnight Moon twenty times over.  Or worst yet, I could give them all diabetes by providing too many animal crackers.

This must have been the thought process of the TSA, since they opened every single bag, took everything out, tested every possible surface of the stroller and carseat, and - as this took half an hour -- made me miss my flight.  Which was the last flight that would have gotten me to Denver on time.

Thanks for keeping us safe, TSA.  After all, now I stand absolutely no chance of an accident or attack on a plane since I won't be getting on one.

I *may* have thrown fit at the gate.  Of course there weren't any passengers there since they'd all boarded on time and the jetway was already closed.

Also, may I just note that I asked the TSA officers MULTIPLE TIMES if I would be able to make my flight.  I also asked them if it was possible to notify the gate that I was being checked and would be delayed.

I "would be fine."  Except I wasn't.

So once again, I am not even close to the baby-making.

Whatever.  At this point -- I am used to it.  And it isn't as if I expect anything but failure anyway.  It just stinks because I really wanted A to meet her surrogate mommy, and I too really wanted to see N. Husband says maybe we will fly out to N's home state of California if this all works out, and go to an ultrasound together.  First of all, that would require a successful transfer, which has happened only one out of seven previous transfers.  Second, I cannot take any days off between January and July and I will be working each Saturday from February on.  So exactly how I am supposed to fly to California, I have no idea.  And I don't remember them doing ultrasounds routinely after the 18-20 week anatomy scan.  We could of course go just to visit, but that would likely be at the same time we want to go to Israel.

Let this not be misconstrued.  I am still quite grateful the transfer is even happening, and grateful to N for going through all this especially without me there.  And I ended up having delightful morning with my miracle baby, the sweetest most amazing little light of my life.  I may never have another baby (despite my mother's unflinching optimism), but I am beyond blessed with the one I hold now.

To adapt my usual end-of-consult line: thank you for allowing me to blog the chronicles of this very "pleasant" (ha!) journey.  Will follow.

Friday, December 4, 2015

Not updates in Internal Medicine, but updates from someone board-ceriotifed in Internal Medicine!

Hello again, dear readers!

First off -- if you had a rough Thanksgiving, I was in that same spot three and four years ago.  I can't guarantee each of you will hold a baby in your arms.  I wish I could.   But I can tell you that even when you are absolutely convinced you will never reach your happy ending, it might be just a matter of time.  My happy ending is currently sleeping tucked beneath a quilt my grandmother made for me.

Since I last wrote, some updates are probably due.

I am now officially certifiable...oops, I mean board certified by the American Board of Internal Medicine.  And yes, I am darn proud.  I may have bought myself a "pass present" in the form of a sapphire ring from -- which would have cost $75, except I had no idea of my ring size and consequently had to order four different sizes before getting it right.

My sweet A is now 22 months, sweet, loving, smart, funny, and generally the light of my life.  But that wasn't news.  She has her own personality.  Tonight she force-fed me cake.  She's also impressive.  We took her to her first Nutcracker last weekend and she watched the entire thing.  Actually watched, interested, enjoying herself.  This, Dear Readers, is a Very Big Deal.  The Nutcracker was my first ballet and the story goes that I thought intermission was the end and consequently threw a fit because I wanted more.  I aways dreamed of taking a little girl of my own to the ballet and now that dream came true.  Also yes, I will never stop wishing I had the talent, turnout, and arches to be a ballerina.

I went to a Mom's Night Out from A's nursery school class last night.  It went better than I thought, considering my social awkwardness.  I made it through the usual birth stories and interestingly, when it came out that we used a surrogate, I got a universally positive response.  When I told them I was a physician, I was also met with unexpected admiration.  It was a good feeling.  Coming from a family of physicians, spending time with friends who are almost all physicians, it seems so normal to be a doctor.  I am incredibly honoured by the privilege it is to practice medicine, but it never occurred to me that it is impressive.  Yet think about all those people who wish they could get into medical school, or residency.  I am pretty lucky.

As for Operation Sibling: we have six chromosomally-normal embryos "on ice" at CCRM and transfer date is approaching.  This will actually be my first time attending a transfer.  Yes, out of seven transfers, I have attended zero.  We already had plans to be in Israel for the first transfer, and after that it was just too painful to be at Northwestern.  Now I'm excited to see it from a medical perspective.  I'm thrilled to see N again.  I'll bring A, so I'm especially looking forward to N getting to see how much she's grown (although I send pictures all the time).  Have any of you attended an embryo transfer?  What was it like?

We have also decided to do a single embryo transfer.  I'm a little worried.  They quoted me a 75% take-home baby rate with our embryo quality (5AA), which is amazing, but still leaves a significant failure rate.  But they also quoted a 60-70% risk of twins, with all the associated complications.  I would love twins if you could guarantee they'd be born normal.  But with a 20% prematurity rate, and a 15% gestational DM rate, and increased preeclampsia, my first priority has to be N's and Baby's safety.  We probably won't have additional children after this one.  It feels wrong to me to keep risking other people's health, and it feels greedy.  before I knew about Turner's Syndrome I always wanted four children.  But some women don't get any children, and I already have one.  So I am pretty lucky, don't you think?  But I do wish we could get to Beta day already.  Positive or negative, I would just like to know.

Lastly...I  it has recently come to my attention that this July I will graduate.  I could be done with training forever.

Let me rephrase that.  After twenty-seven years of formal education, I could be done.  A real adult, looking for a job.

The last time I applied for a job it was a cashier position at Borders.  This was in no way motivated by the 30% employee discount, of course.

Interestingly, there aren't exactly a plethora of jobs in academic infectious diseases.  I don't want to go into private practice.  I want to teach students and residents and fellows.  I want to be a part of grand rounds and morning reports.  But a highly-placed person at our medical school just told me there are no part-time jobs in academic medicine.  I can either have a job that makes me happy, or I can be the mama I want to be.

If you know me at all, you know this decision isn't actually hard to make.  A wins, every single time.  But maybe I don't have to give up on academic medicine?  Mama thinks Highly-Placed Person may be wrong.  It remains to be seen.  But another questions is whether I should take up Highly-Place Person on his offer of a two-year PhD in molecular micro (exact field TBD) which would provide me the research skills I need to continue in academia as well as the funding to do so.  No need to find a grant.

Mama thinks perhaps with a PhD in hand, I could convince somebody to hire me part time.  Anyone out there with experience?  A doctor doctor?

Anyway, my eyes are closing as I write.  Shabbat shalom everyone, and I will try to update again soon.

Tuesday, July 14, 2015

Another update -- also known as procrastination -- Change of place, change of luck

But not too much procrastination.  I do need actually to pass my Internal Medicine boards, after all, and study time is scant.

But in brief: we have decided to change IVD clinics.  I had no great love for our previous clinic, and as it turns out, their rates are below average and overall poor.  I'll not get into specifics but basically we've noted serious detail problems and are ready to move on.  We're considering two clinics.  One is CCRM and one is on the west coast.

A Hebrew phrase goes, משנה מקום, משנה מזל, meaning "change your place, change your luck."  In some ways I feel odd writing that as our darling A is a true miracle.  But I think you all know what I mean.

I won't mention here the name of the centre which I just "divorced."  I don't want to slander or speak ill and I can't remember if I mentioned it previously or not.  I will simply say that I now know a much better centre in Chicago, and if anyone needs the recommendation, feel free to contact me.

Now -- practice exam questions and hopefully a new entry in my journal to A.


Friday, June 5, 2015

In Which Our heroine remembers she has a blog

Hello again, dear readers,

And no, there is no baby on the way as of writing.  Life is just busy.  Good, old-fashioned, real life.  And I'm okay with that.  I think we are supposed to be out there, living real life.

So, you might ask, what is going on in that real life?  A is now sixteen months and counting -- I can't believe it!  She's truly a toddler.  I think the real transition happened while were in Israel, just around her fifteen-month "birthday."  She started walking just before her birthday but by the time we were in Israel she was really running everywhere, and just everything about her went from baby to toddler.  She started protesting naps (and anything else) she didn't want to do with a vengeance.  She doesn't want to sit still, so restaurants were shift-work.

I miss babyhood, but honestly?  This doesn't frustrate me too much other than the obvious nostalgia.  Toddlers are learning independence and trying to understand how to convey their needs.  And A can't speak many words yet, so she's frustrated that she can't communicate.  Throw in the understandably short toddler attention span...

And there is so much sweetness, dear readers!  My little baby (she will always be my baby) has learned to push her babydoll in a toy pram and now she calls herself "mama" and gives her dolly kisses.  She is also learning to play ball, and she is so curious to explore everything.  And she is identifying animals in her storybooks, and at the zoo.  She knows some body parts.  And she is just a silly, adorable, sweetheart.  Every night I tell her she is our daughter and we waited a long time for her, and she makes us the happiest people alive, and that she is the answer to our prayers and the light of our lives.

This would be a lovely way to end this post, except it would be incomplete.  No, there is no baby on the way -- but that is not for lack of trying.  We have had two failed FETs, one in February and one in April.  I struggled to decide on a next step.  But eventually we agreed to do one more full IVF cycle, using the same lovely surrogate but a fresh donor.  (We're out of embryos anyway).  We just chose the donor, so hopefully I will be able to update you with some good news sometime soon.  Our plan is to do a day 5 transfer w PGD to ensure we transfer chromosomally-normal embryos.

On the professional front...the professional front seems to mean so much less to me.  But anyway.  I'm on research right now, working with vancomycin-resistant Enterococcus faecium and the interactions between cathelicidin exposure and daptomycin susceptibility (fancy language meaning I play with resistant bacteria and try to find out if our immune system reacts to them in a way that makes the antibiotic resistance worse).  My co-fellows are a great group.  Learning to work in a lab is definitely a learning curve!

And now?  I have a microbiology practical exam in two days, so it's study time.

Goodnight, everyone, and Shabbat Shalom!