When you are navigating the twisted, poorly lit path from infertility to parenthood, it can feel as if you're in a distorted version of Robert Frost's "The Road Less Traveled". Instead of two roads diverging- two roads sound wonderfully simple!-there are multiple paths, forks, bypasses, and alleys to consider. Do you skip this month's try because you have fewer mature eggs, or do you bet on the one good egg you have? Do you discontinue IUI procedures and save up for IVF and, if so, how are you going to get that money when the roof also needs replacing and your car insurance payment is due? What about embryo adoption? Is it time to quit trying to get pregnant and instead focus your money and energy on adoption, which is expensive but the closest route to a sure thing that you've got?
This line of questioning could go on and on, and for someone like me who can't figure out where she'd like to eat in a small town of about ten restaurants, the options get excruciatingly overwhelming.
That's why I'm feeling a bit relieved to have recently closed one door to parenthood. And by closed, I mean slammed. Dead-bolted. Vacuum sealed. Padlocked. Just two weeks ago, I ended all chances of carrying my own child by having a hysterectomy. And I have absolutely no regrets.
Although I stand firm in my decision, I would be remiss to claim no sadness in choosing it. The women in my family usually give birth to deliciously fat babies, and I have done more than my share of daydreaming about nuzzling plump cheeks, counting arm and leg rolls, and wiping food and dirt from underneath rippled chins. I have longed to sit in a rocking chair while breastfeeding and singing lullabies. Though it is terribly vain of me, I always thought I'd make a cute pregnant woman- all baby and darling in my maternity clothes. And now all my visions will remain just that: sweet visions, not reality. It's sad and it's not fair, but it's also out of my hands. I find more peace in accepting that fact than in rehashing those old daydreams or painting myself as wronged by the universe.
That said, I can assure that I did not wake up one day and decide to have a hysterectomy. I blame the whole thing on the fibroids.
During my first, hopeful ultrasound appointment with the fertility doctor, he asked me, "Did you know you have uterine fibroids?" I did not, and my heart sank as soon as his words touched my ears. Danielle had just tried ten times to get pregnant, and with no success. Now, it appeared I had a fertility obstacle, too. However, the doctor assured me that the location of my particular fibroids would not hinder a pregnancy, so I blindly- even blissfully- continued with IUI procedures.
A few months in, I could feel a small mass in my abdomen that was hard to the touch. I brought this to the attention of my doctor, and he identified this mass as my largest fibroid. Though it was disconcerting to feel this lump in my belly, he assuaged my concerns by telling me that, because of my petite size, it would be easier for me to feel my fibroids, that they would be a bit more obvious in my body than in the body of a larger person. Again, I deferred to him and did not worry much about it. After all, he measured the fibroids at many of my appointments, and he still felt I was a good candidate for IUI. As time passed, I began to unbutton the top button of my jeans when I felt too full and tried not to panic as I felt the mass growing from the size of a fingerling potato to the size of a fist.
Because the growth of my fibroids was of such concern to me, I made an additional appointment with the fertility doctor. The left side of my body was filling up with fibroid tumors; where, I wondered, could the baby fit if I got pregnant, and how could pregnancy be anything but highly uncomfortable at this point? When the nurse midwife and fertility nurse felt my belly, I could see concern and alarm on their faces, which felt validating. However, when the doctor came in to examine me, I got the same party line: Because I am so thin, the fibroids are easier to feel and will seem more prominent, and their location should not affect my chances of becoming pregnant. With this information, I chose to have my fifth and final IUI attempt. However, my intuition told me that this try had little chance of success.
Two weeks later, we learned that my fifth IUI try was, as I had suspected, in vain. Financially and emotionally depleted, Danielle and I stopped trying to get pregnant and put our plans of parenthood on hold.
In the interim, we made a few overtures toward growing our family. The April after the August failed IUI attempt, we visited a different fertility doctor for a second opinion. He was thorough and attentive and gathered more information about my fibroids. He corroborated some of what our original doctor had said about the location of my fibroids but also confirmed some of my worries. While my fibroids did not disturb the function of my ovaries and would not affect my chances of becoming pregnant, this second doctor said that he would not perform IUI on me until the fibroids were gone because I was at high risk for miscarriage or pregnancy complications as long as these tumors were hanging around my uterus. This information rang true and validated what my intuition had been telling me for months: I had no business trying to get pregnant while my body was housing these problematic fibroids.
At this second opinion appointment, we also discussed the possibility of harvesting my eggs (I don't mean to brag, but I had an awesome store of healthy eggs.) and having Danielle carry an embryo made with one of my eggs via IVF. She had the great uterus, and I had the great eggs, so this option was a viable- albeit expensive- alternative for us. Of course, due to the cost, we needed some time to mull this decision over.
In July, we met with our original fertility doctor to discuss IVF as well as the possible removal of my fibroids. At this appointment, we sat across from him in his office, a dark wooden desk separating us. He did not feel my belly to check on the growth of the fibroids, and he did not measure them on an ultrasound. Again, I heard the message that it was not medically necessary to remove them, that it just depended on how symptomatic I felt I was. We didn't leave that appointment with much resolution, but Doctor 1 put in a phone call to Doctor 2 about scheduling an appointment to discuss surgically removing my fibroids, as Doctor 2 would do this laparoscopically, yielding a faster recovery time.
As it turns out, I never heard back from Doctor 2, and although I was instructed by Doctor 1 to contact him if I did not get a response from Doctor 2, I ended up doing nothing. Doctor 2 practiced in another state, and I worried about insurance coverage should I cross state lines for a surgery. Furthermore, the words not medically necessary repeated in my mind on a loop; how could I justify spending my family's money on a surgery that wasn't truly needed? It felt selfish even to pursue this route.
I ended up waiting a year and half to act on my worries. For eighteen months, those insidious fibroids grew. And grew. And grew.
Without ultrasounds, photographs, or any kind of measuring equipment, I could mark the expansion of my fibroids. Over time, the lump in my abdomen spread all the way from my pubic bone to the inner edge of my hips and was about the length of my hand when measured from my wrist to the tip of my middle finger. The entire left side of my belly was full, so much so that there was a visible and noticeable slant to my abdomen when I lay on my back in the bathtub. In fact, sometimes I avoided taking a bath because the sight of these fibroids pushing against my skin unnerved me so. I looked like one half of my body was pregnant, only without the amniotic fluid or the joy. It seemed an unnecessarily cruel joke: something was, indeed, growing inside my body, but instead of a baby it was a scary, ugly, painful, and unwanted thing.
I decided that I needed to be a better advocate for myself and my health, so I made an appointment to see not my fertility doctor but instead my local physician's assistant. She is a kind and empathetic listener, and she does not rush to over-treat or overprescribe. I wanted to get her opinion on this matter.
Perhaps it should have been frightening to me to hear her exclaim, "Oh my God!" when she pressed on my belly and felt my fibroids for the first time. Instead, I felt great relief. Finally, someone was taking this seriously, and no, I wasn't crazy to worry. "This has got to come out," she kept repeating. Before the appointment was over, she had already made arrangements for me to get an ultrasound as soon as possible, and she referred me to a local gynecologist and surgeon for further examination. While I was thrilled to finally be making headway against my bothersome fibroids, the physician's assistant said a word that caught in my throat each time I tried to talk about it: hysterectomy. Because my fibroids had grown so large, she couldn't see another way to get them out.
The reality of this potential surgery and the permanence of it left me in a daze for the rest of the week. At 33 years old, I was not prepared to walk away from any chance of carrying my own child. While it was true that the pregnancy ship had pretty much sailed for me anyway due to the fibroids and the expense of orchestrating a pregnancy around them, I was not prepared to let go of my dreams of chubby cheeks and maternity dresses. I was in a very real state of shock, and many of the emotions of infertility that had been sleeping over the past several months woke back up with a start.
After a colorful ultrasound appointment in which the technician exclaimed, "Good Lord, Sister!" when photographing my fibroids, it was a real mercy that I had to wait about two months to get an appointment with the surgeon. By this time, I had had some time to process and accept the possibility of my needing a hysterectomy.
I cannot speak highly enough of my surgeon. At my initial appointment, he spent an hour talking with me, discussing my symptoms, feeling my belly, and gathering his own ultrasound data. He told me some of the same things I'd heard from the first two doctors, but he did so in a more thorough way that also acknowledged that my fibroids were, indeed, pretty large. Instead of hearing that surgery was not medically necessary, he told me that it was not medically necessary, but......
I would be fine to wait to remove my fibroids, he said, but they would continue to grow due to my age and hormone health. Surgery was not medically necessary, but I would become more symptomatic as the fibroids grew. I could postpone surgery, but the surgery would get more complicated as the size of the fibroids increased. I could live with fibroids in my body, but they could grow up past my waistline and bellybutton. I did not have a medical reason to have surgery, but I could make the choice to have the fibroids removed if it would improve my quality of life. He did not push me into having surgery, nor did he push me into making a quick decision. However, now that the words not medically necessary were followed by additional information, I felt more prepared to act. At the end of this initial appointment, the surgeon set up a follow-up appointment for the sole purpose of talking about options and answering any questions I had. He was wise enough to know that additional questions would arise once I'd had some time to digest what we'd discussed at the first appointment, and I was most appreciative of his thoroughness and care.
Given all the hoops Danielle and I have tried to jump through on our path to parenthood, it should come as no surprise that babies were on my mind as I awaited my follow-up appointment with the surgeon. Now, at 33, I felt comfortable moving forward with a hysterectomy, but would I regret my decision at 37? Were there other fertility options for me, and how drastic would they be? Once I agreed to a hysterectomy, there would be no turning back, so I needed confirmation that I was making the right choice.
At my follow-up appointment, instead of asking questions about the length of the surgery or the type of procedure the surgeon would do, I peppered the doctor with questions such as, "If you didn't do a hysterectomy, what type of procedure would you do, and what would my chances of pregnancy be?" and, "Would it be possible to harvest my eggs later since I am keeping my ovaries?" In typical fashion, the surgeon did not answer in absolutes. Yes, it might be possible to remove the fibroids without taking my uterus, but it would involve a trip to see a highly specialized surgeon at a facility like Duke or Chapel Hill, which is not a quick or convenient drive from our home. Even so, the size of my largest fibroid and the way it was pushing on my uterus would make it a difficult surgery and one without a guarantee that my uterus would be spared. Likewise, it might be possible to harvest my eggs at a later date, but again, this would take a great deal of skill and specialized knowledge. As the doctor spoke of these options, I saw dollar signs and a lot of unwanted emotional and logistical stress. I have never been a big believer in taking drastic measures when it comes to medical decisions. I would not want to be kept alive on a ventilator if I were brain-dead, for example. Likewise, my desire to carry my own child was not strong enough to justify driving several hours to doctor appointments, paying for hotel rooms and gas for the car, taking time off of work, and re-entering the ups and downs indigenous to the terrain of infertility. Even then, all that effort would be put into a chance- just a chance- of getting pregnant. I felt a sense of peace as I remembered my real priority: becoming a parent. I knew I could still be someone's mom without a uterus and, with the fibroids gone, a healthier one at that. With a sense of calm and certainty, I scheduled my hysterectomy.
I am now almost two weeks post-op and feeling great. The type of surgery I had, a laparoscopically assisted vaginal hysterectomy (LAVH), typically takes about an hour to perform. Due to the size of my fibroids, the surgeon predicted that my surgery would take between two and three hours. In reality, I was in surgery for six hours as the surgeon tried to break apart and loosen that stubborn largest fibroid. My fibroids had already grown up into my rib cage, and the lover of gross science in me cannot wait to get a final weight count on the total mass of the fibroids. My mom said that the largest fibroid was actually the size of a small melon, which would go a long way in explaining why my pants were getting so tight. (And there I was blaming chocolate and wine!) All this is to say, it's good I had surgery when I did. I cannot imagine how complicated things would've gotten had I waited longer and let the fibroids continue to grow. By having the hysterectomy now, I have spared myself from a more invasive, painful surgery. For that, I feel deep gratitude.
Strange as it seems, I feel such relief to know that I will not be able to carry a child. If I hadn't already experienced the upheaval infertility brings to one's life, I am sure I'd be devastated right about now. However, I have grieved enough over unsuccessful pregnancy attempts to last a lifetime. In many cases, it wasn't the failed attempts but instead the long periods of not knowing that were the most taxing. It is excruciating to know you are about to experience either deep grief or great joy and that the whole process is beyond your control. To hope is scary but to self-protect seems cynical. You don't know what to think or feel- or you feel it all- and, to further challenge you, you can't have wine or coffee. In the end, letting go of that pendulum feels like mercy and grace. There is a certain peace that comes from simply knowing.
And here is what I know: I know I won't be able to get pregnant. I know I am through with checking my temperature and tracking my cycle. I am sure I'll never need an ovulation predictor kit again. It is certain that I am through with fertility appointments and hormone medications. I know, without a doubt, that I will not have to utter the words "two week wait" again.
I also know that Danielle and I can move forward with adoption now that pregnancy is not an option for us. As our options narrow, so does our focus. Our goal becomes clearer and the steps to take more obvious. The "what if's" are fewer, as are the number of roads diverging. No, we are not out of those darned woods yet, but the paths are becoming easier to see.
One day, I hope we'll find the one that will make all the difference.
Monday, March 23, 2015
Tuesday, March 17, 2015
A Wedding in Three Acts
Act I
Our first wedding was beautiful. It happened on a sunny September afternoon on a farm with 125 supportive friends and family members surrounding us. People traveled to our Carolina celebration from as far away as Boston, Delaware, Pittsburgh, and Pensacola. We rented a huge tent, bought tablecloths, sewed table runners, and topped every conceivable surface with mason jars crammed with local wildflowers. A food truck catered dinner, and we made little paper bag lunches for the kids. At the fire pit, guests roasted s'mores, and as the sun went down folks gathered around the fire to play instruments. Aside from people who like to dance (We, being your typical uncoordinated white people, had neglected to even think about providing a proper space and proper music for dancing.), everyone had a great time and lots to do.The ceremony was sweet, too. Danielle got choked up saying her vows, and I saw glimpses of many of our guests getting teary-eyed as well. The words we spoke were beautiful. I love you. I trust you. I delight in you. For my part, I avoided any kind of emotional expression by obsessing over the amount of gnats resting on my arm on this muggy, late-summer day. I felt like I had pin pricks in my skin running all the way from my shoulders to my wrists and wasn't sure what to do about it. I'm no Emily Post, but I'm pretty certain it isn't good form for a bride to swat at bugs and flail her arms incessantly while solemnly swearing faithfully to love and support another person for the rest of her life. (And can you imagine how the pictures would look?)
Gnats aside, it was a lovely day. We got to visit with friends we hadn't seen in a long time, receive countless hugs and well-wishes, have fabulous hair, and feel incredibly validated and affirmed. Our outdoor wedding had no trace of rain, and our guests lingered to talk, eat, drink wine, play music, and just savor the last remnants of summer. It was pretty much perfect.
However, legally speaking, our vows held the weight of a heaping helping of diddly-squat.
There have been many times when this fact has angered and saddened me. The extreme of unfairness of denying marriage rights and protections to same-sex couples is downright infuriating.
And yet, today I feel grateful.
Why the change of heart? Because on February 14, 2015, I got the chance to say my vows all over again. And it was even better.
The road to being able to legally marry in our state was a windy one. Less than three years ago, our state passed a constitutional amendment banning same-sex marriage. Danielle and I had serious talks about moving from a home we love- and living farther away from our families- in order to reside in a state where we could legally wed. Temporarily, our love of place and family won out and we stayed put, but we were left feeling vulnerable in the absence of legal rights. We discussed traveling to Maryland over the summer to obtain a legal marriage license, but we knew the futility of such a trip: the license would be null and void as soon as we crossed over the state line.
So we carried on in this state (no pun intended) of legal limbo for some time. Then, one day this past November we started seeing Facebook posts about gay marriage becoming legal in our state. Perhaps past experiences had conditioned us against optimism because our first response to the news was incredulity. Surely there was a catch. Perhaps this was one organization's take on a recent court ruling and not the voice of the state speaking. Yet post after post kept popping up in our feeds. Apparently, a regional court ruling coupled with our Attorney General's refusal to defend the state's gay marriage ban had indeed paved the way for us to legally marry on our home soil. We were, of course, thrilled but also shocked. We had no inkling that a court ruling was in the works. There was no gripping story line we were following, no waiting with bated breath. The day we had long been waiting for had arrived, but anticlimactically so.
Act II
Fast forward to December 31, 2014. To end the year, Danielle and I paid a visit to the Register of Deeds office two counties away to obtain a marriage license, although the getting there almost jeopardized our relationship. (Okay, not really, but it makes for an entertaining story.)On one of our last days off for winter break, Danielle and I decided to make it official and headed to a county office about an hour from our house to take care of the legal paperwork. We did this for two reasons. First, we wanted to avoid getting our names in the local small-town paper, and secondly, the other county has better restaurants. So we decided to have a celebratory brunch at one of our favorite breakfast spots. En route, we stopped by our local health department so that I could get my blood drawn as part of preparation for an upcoming surgery. This blood panel involved fasting, something I don't do well. After getting blood drawn, Danielle drove my coffee-deprived, empty-stomached self an hour down the road to get a much-needed hearty brunch.
Something to know about me: I am an eater. I do not skip meals. I do not forget to eat. How does a person forget to eat? That's like pushing a gas-depleted car down the road for miles and then saying, "I didn't know the tank was empty." I could be asked to sing in a concert with Patty Griffin and Emmylou Harris, my two all-time music idols, and I would make sure I had a pre-concert snack. By the end of the show, I'd also be hoping the ladies would wrap up all their unnecessary singing so we could go out and get a nice dinner. I'd be planning possible restaurant options and thinking about what I might order in each establishment. When I am hungry, food pretty much trumps everything.
All this is to say that Danielle found herself in a pretty precarious position that late morning in December when we arrived at our destination only to discover our restaurant of choice to be packed and overflowing with customers waiting outside in the cold just to get a table. Outside. In the cold. I can't remember my exact response, but I'm certain I did not handle this well. On our way there, we had passed another breakfast place I was interested in trying, so we decided to go there instead. However, my warped sense of direction caused me to advise Danielle to park about a mile away from the aforementioned restaurant. We walked several blocks in the cold and wind before confirming my error, so we had to get back in the car and drive our caffeine- and carb-craving selves to a closer parking space. When we finally arrived, we discovered a line, but at least this one was indoors only. The place was crowded and cramped, and we were a little grouchy because we didn't know the procedures and couldn't find a menu. In other words, it was a wonderfully romantic start to our wedding proceedings.
Eventually, a menu got passed our way, we chose wondrously decadent meals and fancy coffee drinks, and we shared a cozy meal together. Danielle took photographs of the designs in our ultra-creamy lattes, and I loaded a biscuit with innovative toppings like tomato jam and strawberry-rhubarb preserves. My hunger satisfied, more sane feelings like gratitude and joy rose to the surface of my consciousness. Now that our blood sugar levels were stabilized and our capacity for being loving wives was restored, Danielle and I walked starry-eyed back into the cool air and headed for the office of the Register of Deeds.
This should be the ending of this part of our happy story, but our legal paperwork-y day included an unexpected twist: a visit to the bank. (You know how the song goes, "Goin' to the chapel and also to the bank, and we're gonna get ma-a-a-ried"? Yeah, me neither.)
When we reached the Register of Deeds' office, we were greeted warmly and congratulated by one of the office workers. She asked if we were getting married in the state within the next 60 days, which we confirmed. "Great," she said, "then all I need to see is your driver's license and Social Security card." I opened my wallet and produced both of these items, but Danielle said, "What?" She had her driver's license, but her Social Security card was in a lock box at home....an hour's drive away. The lady at the front desk then suggested that she could also accept another item with Danielle's name and Social Security number on it, an insurance card perhaps?
You would be amazed by how many personal documents do not contain your Social Security number. In general, this is a good thing, but it was most inconvenient at this specific moment.
Finally, the woman at the desk suggested a last-ditch solution. If we banked at a local bank, we could get a typed letter on company letterhead listing Danielle's name, address, and Social Security number. This solution was workable, and as luck would have it, Danielle's bank was just a couple of blocks away from the Register of Deeds' office. So we moseyed down the street to obtain the letter, took a selfie in front of the bank, and returned to complete our legal paperwork.
In keeping with the anticlimactic nature of our same-sex marriage, filling out the requisite paperwork was a breeze. In fact, I'm a bit disturbed by how easy it is to get married. There are virtually no hoops to jump through, unless you are no longer able to recall such basic personal information as your address or your mother's name. (In which case, you may have some more pressing matters to attend to.) Paperwork obtained, we were ready to embark on the final step of our legal wedding: the ceremony. Because we wanted to have close friends and family around for this final step, we opted not to go to the Justice of the Peace and instead contacted our priest. We were ready to set a date.
Act III
In choosing a date for our legal and final wedding, we had no particular preference within the 60-day timespan, so we asked our priest what dates might work for him. He offered up a lineup of Saturdays, but one stood out: February 14th, Valentine's Day.
Valentine's Day has never been a favorite holiday for either Danielle or me. In high school, my friends and I referred to the date as "Singles Awareness Day," and my college dorm friends and I even created a fake sorority, DDW (Dateless Dirty Whores) to commemorate the day. I have never craved gifts of roses, giant cards, and stuffed animals, and I doubt I ever will. Still, Danielle and I never pass up a holiday that might allow us to go out for a fancy dinner date, so we do observe Valentine's Day as a couple these days.
Danielle and I already have two anniversaries we celebrate. The first, on September 17th, marks when we officially became a couple. When planning the first wedding ceremony, we had hoped to use that date, but the venue we wanted was not available at that time. Therefore, the anniversary of our first wedding falls on September 24th. Not looking for another anniversary date to remember, Valentine's Day worked perfectly for us. It was a date when we would go out for dinner anyway and a date the card industry won't let us easily forget. Besides, we could do worse than publically professing our love for one another on a day dedicated to the celebration of love.
This second ceremony was so much easier to plan than the first. Just a few friends and family members were invited, and we decided to do a potluck brunch for an after party. Because of the new state laws, our sweet, small, and simply beautiful Episcopal church was available as the location of our same-sex marriage ceremony. Our kind and patient priest gathered the appropriate liturgy for a marriage service and generously accommodated our last-minute decisions regarding readings and music. I found a passage from Rabbi Harold Kushner that I felt summed up our relationship, and when I read it aloud and it made Danielle cry, I knew it belonged in our service:
"I was sitting on a beach one summer day, watching two children, a boy and a girl, playing in the sand. They were hard at work building an elaborate sand castle by the water's edge, with gates and towers and moats and internal passages. Just when they had nearly finished their project, a big wave came along and knocked it down, reducing it to a heap of wet sand. I expected the children to burst into tears, devastated by what had happened to all their hard work. But they surprised me. Instead, they ran up the shore away from the water, laughing and holding hands, and sat down to build another castle. I realized that they had taught me an important lesson. All the things in our lives, all the complicated structures we spend so much time and energy creating, are built on sand. Only our relationships to other people endure. Sooner or later, the wave will come along and knock down what we have worked so hard to build up. When that happens, only the person who has somebody's hand to hold will be able to laugh."
My parents, who were tremendously supportive of our first wedding, seemed even more excited about the legal ceremony. My mom called me multiple times to ask what they could bring for the brunch, if they could bring a cake, and what colors should be on the cake. I think every daughter wants her mom to be involved in her wedding, and it was so nice to experience her enthusiasm and joy about our big day. My folks also read the readings we selected for the day, and they teared up in all the right places. Our one regret from our first wedding was that we didn't have a toast, so we got my parents to give a toast as part of our brunch. They said very heartfelt and meaningful things, and one of my friends confessed that she had to reach for another tissue each time my parents got up to speak. The whole thing was very, very sweet.
Danielle outdid herself by making platters and platters full of food for the brunch. My mother felt so sorry for her slaving away in the kitchen, and Danielle tried to explain the phenomena of actually liking to cook, an affinity that does not seem to run in our family. Danielle also took the day off of work before the wedding and bought tons of flowers for decoration. (Another benefit of a February 14th wedding- there is no shortage of access to flowers.) Most of what she purchased were live plants, so her gardening wife looks forward to planting our wedding hydrangeas, Lenten roses, Calla Lilies, and azaleas very soon! It will be lovely to walk around our yard, see the plants in bloom, and remember our special day.
I still mean them, and I always will.
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