תירבחו ותסעדו! Tirvahu vetis'adu! It's mimouna time!!!

Another Pesach (Passover) has come and gone, and hopefully spring is on its way.  It's fascinating -- somehow my mood always brightens at this point, as if the spring and I are linked.  Guess my very cloudy home state does have an effect on one's affect :o)

I am especially happy today, since I just finished my last ever working day as a medical student!  We have lecture tomorrow and practical and theory exams on Friday, but I haven't gotten nervous yet.  (Don't worry -- check back tomorrow and the butterflies will most definitely be fluttering about my belly.)  We are celebrating tonight with the (albeit one-day-belated) Moroccan Jewish tradition: the MIMOUNA!!!  Neighbors go house to house eating sweets and a special bread called mufleta.  Any and all are welcome, so stop by tonight and we will greet you with the traditional "tirvahu vetis'adu."  There is also some connection to luck and to fertility, so who know?  Can't hurt.  Unless you're diabetic.  Or have dental caries.  Or just don't like sweets.

But for the rest of you, happy Mimouna and I will update more baby news as it comes in.  Right now, tfu tfu tfu, things are going along...

Once again I am passing through Chicago, but this just connecting through.  The writing-and-medicine conference went swimmingly, although Abraham Verghese did not attend, which made it decidedly less amazing.  But I mustered up the courage to read a poem and an excerpt from a short story at a well-known bookshop, and nobody hissed, so I guess it went about as well as can be expected.  It was five minutes of terror, with the added delight of larygitis making it barely possible to finish reading.  When I was done and all the adrenaline departed my body I practically collapsed on my way back to my seat.  But I made it.  And today we ran our workshop, which also went well.  Now it's back home via Chicago.  I won't land at home until night, and then another half-hour or forty-five minutes until home-home.  But oh, well.  I also wrote a poem during the conference of which I am not ashamed.  I may post it tomorrow when I unpack.

I do have baby news, though, which warrants posting.  Our surrogate and donor both had their baseline ultrasounds, and everything is going (tfu tfu tfu) according to plan.  Maybe this will actually work out!

For now I will end with this brief posting as we will board our plane soon.  More details to follow.

When it comes to statistics, caveat emptor (aka In Which our heroine displays perhaps a bit of bitterness)

I receive weekly updates, along with the rest of medical-school community, on new and exciting developments at our institution.  Today, I learned that our Reproductive Endocrinology and Infertility Department is highly successful; indeed, well above the national average.

Congratulations.

Wait.

Could it be the reason behind the success rate is people like me?  People turned away outright?  If the statisticians included us rejects as failures, maybe the statistics would look different.  I'm not advocating futile IVF cycles or endangering the life of myself and fellow members of the aortas-more-fragile-than-porcelain club.  (According to Them.  I am NOT that breakable!)  It just upsets me to think about how different things would be if I were allowed to get pregnant.  Nobody would have to know I couldn't have children.  My parents wouldn't have to spend their hard-earned savings to fund this project.  We wouldn't have to travel back and forth to Chicago.  My best friend could have been our ovum donor.  We wouldn't have to outsource the most precious cargo ever.  My Bubby and my Aunt J would have known a child was on the way.  And maybe they would have held on just a little bit longer, knowing...

Maybe part of this is also about what makes me a girl.  Genotypically I'm not playing with a full deck of cards...er...chromosomes.  Phenotypically -- it's all thanks to pills.  Yes, I can wear makeup and dresses, but so do the drunken transvestites I treat in the Emergency Dept.  I guess maybe I thought pregnancy would prove my girl-ness.  After all, you can't get more female that that!

But there's nothing I can do, and as I wrote before, I am grateful that motherhood is still a possibility, and I have to remember that my goal is a baby (or two) in my arms, not my belly, and not (God forbid) in a stroller at my graveside.  So begone, bitterness!

In Which our heroine lacks completely any courage, but shares new research and good news

The brief news of the day is that I got up the gumption to call our surrogate, say hello and touch base, since we weren't allowed to contact each other until after the contracts were in place.

When I say I got up the gumption, I mean...sort of...may have addressed several other tasks on my to-do list and some not on my to-do list before dialing.  And I may have breathed a huge sigh of relief when nobody answered.

I called myself their "friend from _____" on the message since I don't know who might listen to their messages -- they have children and live in a small community.

News for the scientifically inclined:  Research about Turner's Syndrome made a recent issue of the New England Journal of Medicine!  The article is entitled, "Growth Hormone plus Childhood Low-Dose Estrogen in Turner's Syndrome" and describes a randomized, double-blind, placebo-controlled trial.  The abstract is free, and subscribers may read the full article.

Little other news.  Got a completely overinflated but fun to read evaluation for my January elective, had a wonderful time celebrating the wedding of two of my best friends (CONGRATS to the new Mr. and Mrs. C!!!  We love you!), and received heart-warming feedback on a short-story collection.  I'm reading one of the stories aloud at an upcoming conference.  No, I shan't say where! :o)  All I can say is, I hope Abraham Verghese shows up, and if he does, I hope he agrees to autograph my copy of Cutting For Stone.  I'm unlikely to accomplish this since I will probably be speechless and unable to blink, and since it's unlikely he will even show.  But can't a girl dream?

Practical Advice

Considering that my original purpose in recording Mim's Adventures in Motherhood (or the search therefor) was to assist other couples by describing what worked and didn't work in this complex baby-making process, I have spent an inordinate amount of time on silly things like chronicling my day-to-day life and on random worries and musings.  I thought it meet that I should set forth some actual, practical advice.

1. If you can free up an hour between 9:00am and 5:00pm on a regular basis, it's very helpful.  You'll need this time for phone conferences with lawyers, scheduling appointments for doctors, calling insurance companies and billing departments and pharmacies, etc.  Some communication can be done by email, and searching for egg donors is a completely on-line process if you use an agency, but there are many times when you actually need to talk to a real, live, person.  And those real, live people inevitably work shorter hours than do you.  It's been easier, I think, to get excused for an hour to conference with lawyers or a day to fly to Northwestern Hospital than it would be were I a resident.  I have no idea what it's like holding a Real Job.

2. If a bill does not make sense (and there will be so many bills!) then don't hesitate to call and ask for an explanation.  It's also wise to record what you pay, and what it covers.

3. I know some infertility websites recommend not going to baby showers or baby-full events while struggling with infertility.  My take is somewhat different.  You have a chance to celebrate a wonderful occasion and share in someone's happiness.  You can't ever get that time back.  So you might as well celebrate.  You could actually enjoy yourself -- it IS a party, after all.  I'm not saying it isn't sometimes painful.  I found the hardest part to be afterward, when you don't have to put on a public face anymore.  That's when you need to find a good way to handle the sadness, cheer yourself up, and cope with the envy.

4. On a similar note -- if you are a medical student or an Emergency Medicine resident and will therefore rotate through OB/GYN, it will be an emotionally taxing month.  You might not realize it yourself -- I just thought I was becoming a cranky, irritable person -- until my internist/mentor/unfortunate listener to my constant whining until she leaves our institution this June suggested there was a reason I felt ready to snap at everyone.  My advice is to recognize it will be rough, and put a support system in place.

5. A silly little piece of advice: if you are a young woman with Turners and they want to document Premature Ovarian Failure by taking you off your hormone replacement for 4-6wks, dress in layers.  I had at least twenty hot flashes a day.  I also discovered it made them worse if I found myself embarrassed or nervous -- basically anything that activated my sympathetic nervous system.  I'm told soy helps.  It's a phytoestrogen, basically a very low dose of estrogen.  You can by it at health food stores and it shouldn't affect measurements of estrogen, FSH, or LH because the dose is low.

6. We are using New Life Agency for maternity coverage for our surrogate.  I spoke with them on the phone and they were quite helpful about explaining things.  I recommend calling an insurance broker as soon as you sign the surrogacy contract.  You should have an idea of which company you will use beforehand, as it may be part of your contract.  (It was in ours.)  We will be purchasing our insurance later this week, even perhaps tomorrow.  Both we and our surrogate have to apply.  The broker said our application is much simpler.  At least something is simpler!

7. It's sometimes difficult, but don't forget to be grateful.  For Rosh Hashanah, the Jewish New Year, I spent at least an hour listing all the people and things in my life for which I am grateful.  Not just big things -- little things too, like a really good cup of tea.  It's a worthwhile exercise for putting things in their proper perspective.  We are grateful to our family for their generous support.  We couldn't do this without them.  And I'm not talking only about their generosity.  Their love and encouragement and support of how we have chosen to build our family are more than we could ask.  We are also grateful to our friends for their constant encouragement and support, and to two special friends for a offer far above and beyond the call of duty.  And then there's someone else to whom I am just so grateful and who has kept me grounded throughout this process.  I hope she knows who she is.  Thank you, everyone.

See?  And that was just five minutes of big thank-yous, and I'm not even done!  But you probably wish you were done reading this lengthy blog a long time ago, so I won't torture you with anything further :o)

A good news update, a maths interlude, and the confessions of a worrywart

I'm late to announce some exciting updates, but it's been a very busy.  I'm even sure what day it is, actually. Yesterday I had orientation for my new rotation, drove forty-five minutes to present a poster at a conference (but also had the chance to meet up with one of my favorite professors from undergrad), came back from the conference for family dinner, and worked a midnight shift.  I have another midnight shift tonight, so I've been sleeping off and on today, with a little television interspersed.  Kudos to Husband for a delicious lunch :o)

But enough beating around the bush.  We have good news!  Firstly, Husband got a job!!!  It's a great opportunity and we are thrilled.  He can even continue his master's classes.  Secondly, the surrogacy contracts are signed, sealed, and delivered!  Medications are on their way to the donor and the surrogate and the check for the surrogate's expenses is deposited in the escrow account.  We're hoping for implantation between May 6-11.  All that's left is purchasing the surrogate's maternity coverage.  I've never applied for health insurance before for myself, let alone someone else.  Hopefully it's not too complicated!

Let's break briefly for a maths lesson.  If we implant two embryos (our plan), using a 50% success rate per embryo and assuming each embryo is unaffected by the other, we have a 75% chance that at least one will take.  But 30% of pregnancies end in spontaneous abortions.  I'm hoping the risk diminishes since the doctors usually try to pick the "best looking" embryos for implantation.  But it's beyond anyone's control what happens after implantation, except for God, of course.  Hopefully He will be  generous.

Now that motherhood seems like a (faint) possibility, I'm nervous.  What if I don't have the stamina to care for children?  I used to run six miles a day, five to six days a week.  But since a bad bout of bronchitis in September I haven't regained my energy.  I come home from the hospital exhausted and wanting only to sleep.  Even making rounds (when students and residents present patients to the Attending) wipes me out.  If we are blessed with children next February, I'll be six months into an internship front-loaded with difficult rotations.  How will I care for children if I'm even more tired than now?  In answer to certain people I do eat plenty (too much).  I'm sure this is nothing serious but I hope my energy returns before Baby (babies?) come.

And then I worry about something else.  While I always thought I was strong physically, I am the first to admit to being an emotional wimp who flies off the handle far too easily.  I can't do that with children!  I have to learn to keep my wits about me so that I can be a responsible parent.  Hope I'm able!

And one last, unrelated thing.  I am SO NOT READY for internship!  I just can't seem to put a case together the way a senior medical student should, and it is concerning.  I wouldn't graduate me right now (or at the end of May).  Let's just hope tonight goes better than last night, where I couldn't think clinically to save my life.

And on that note...time to nap so that I am fresh for tonight's patients.  Goodnight and good week!

To Chicago and back in a day -- how disorienting and exhausting!  It oughtn't to be, considering that the fight is short.  I guess it's just the nature of travel.  Our day went like this:

5.20am: alarm goes off, time to rise and shine...wait...it's pitch black.  Good thing I get up this early every day and am used to it.

5.45am: out the door, driving to the airport.  Still dark and midnight and in addition it's pouring rain.  We can barely see the lane lines.  Thank you, wonderful husband, for handling the driving!

6.15am: Hello, airport.  The security screen is slow, and they're using the new full-body scan technology, which slows things even more and makes one feel as if somebody is taking a mug shot in prison.  We make it to our (very far away) gate with time to spare.  The plane is fifteen minutes late.  I use the time to make myself up.  I don't know why, but I always find myself doing so when I go to a doctor's appointment.

7.30am: takeoff!  We spend the next forty-eight minutes dozing.

7.45am, Central Time:  Hello, O'Hare, International Airport.

One blue line train and one red line train later...(plus the requisite argument that has to pop up every time we travel)

9.30am: Downtown Chicago.  My husband navigates from the train to the hospital.  Brief stop into the nearest Corner Bakery for oatmeal  -- and cookie, it comes with a cookie! -- and tea.  This is, you see, the breakfast of champions (and medical students needing sustenance for rounds).

9.45am: check-in at the REI office.  Eat oatmeal and sip tea (and the cookie -- can't forget the cookie).  (Requisite make-up following requisite argument.)

10.00am: meet with nurse coordinator to fill out lots of paperwork.  Husband answers lots of infectious disease questions.  Nurse coordinator explains what we need to do to get the IVF meds where they need to.  All contracts need to be signed by 7 April.  GOOD NEWS: We are on schedule for implantation sometime between 6-11 May!  We'll be out of the country visiting my husband's family for two weeks, but since he will already have done his part, and I have no part, we can wait for the call as easily overseas as we can at home.

10.30am: meet the doctor.  Brief history: Husband is healthy except for hyperlipidemia controlled on rosuvastatin, with stable elevation in LFTs.  Brief physical exam: lungs CTAB, heart S1, S2+ RRR no m/r/g.  He listened to the heart through clothes.  And he did not find the PMI or check for lifts/heaves first.  I did not point this out.  Tempting, yes, but a detailed cardiac exam is not necessary for the purpose at hand.  Apologies to Osler.  I turn around while the doctor swabs my husband to check for GC and chlamydia, which I certainly hope is a mere formality!  (It is however apparently quite painful, Husband reports.)  And then it's out the door without so much as an explanation of the IVF process.  The consent form explains things in detail, and I pretty much know anyway.  I ask my husband if he wants to read the form and he doesn't.  So like a man.  You would think the science would interest him, considering he's an engineer, but apparently not.

10.45am: down the hall and to the right for bloodwork.  I sit and try to read about glomerulonephritides while Husband gets six vials of blood drawn.  He comes back and announces that this is his new record for bloodwork.  I guess it takes a lot of blood to check HIV, RPR, Hepatitis panels, blood type and Rh status, and probably more things I can't remember.  I suppose I don't mind being spared the needles.  Husband is a gem and doesn't complain.

11.00am: sit with husband while he eats lunch in the hospital's Au Bon Pain, which, incidentally, is nicer than ours.  He buys two sandwiches and I buy one to eat later.  I end up taking a bite.  No flavor.  I can't bear to throw it out, so we wrap it up and save it for later.

11.30am: back upstairs.  Husband has to -- how shall I put this -- provide his genetics, which get frozen until the X chromosome is available.  I pass the time braiding my hair and reading the latest issue of Journal of General Internal Medicine.

12.00pm or so: back on the sidewalk, headed toward the train.  It's chilly outside but not so unpleasant that we don't window-shop.  We are, after all, walking the Miracle Mile.  It's fun to be part of a bustling city with streets full of people and fancy stores and street vendors (and even the occasional mendicant).

one red line train and one blue line train later...

1.00pm: O'Hare International Airport again.  I feel like I've got deja vu.  The security line moves far more smoothly here.  Once again, I have my prison intake scan.  I'm hungry and hoping to find something tastier than the sandwich.  We walk by every single food stand in the nearby terminals but nothing is that appealing.  We also almost miss the sign to our gate.  When we finally arrive at the gate there isn't a single seat.  I sit on the floor eating the sandwich (at least it tastes a bit better seasoned with hunger) and Husband stands and talks to his classmates on the phone.

2.00pm: board the plane

2.30pm: takeoff!  We are both so sleepy that we don't even awaken for the beverage service.  Husband is very thirsty and frustrated that he doesn't get his water or his orange juice.

4.45pm: Eastern Time: home sweet home.  We drive to the university so Husband can make it to class.  We're too tight on time to drop me at the medical school where Mama is waiting to give me a ride home, so I go with to the College of Engineering.  Mama says she will be there in about twenty minutes.  Fifty minutes later (twenty of which I wait outside in the damp chill and lose all feeling in my extremities) Mama finally picks me up.

7.00pm: walk in the door of my house, nibble at the leftover cake from my best friend's shower, pour myself a cup of tea, and read email.

8.30: Husband arrives home.  Kiss him hello and go shower while he watches television.

9.20pm: In bed, hair blown dry, lights out.

10.48: Mama calls to tell me she doesn't need a ride tomorrow.  I guess I will do the 5.45am commute alone.

And that's a wrap!