Answers That Come in the Form of Questions

When you think about getting answers to something, we almost always think in terms of facts. How tall am I? I’m 5’1.5” (that half inch is very important). When is my birthday? May 11. We ask a question, and there’s a definitive statement that answers the question. Certainly there are philosophical questions that can be debated, or for which we may never fully understand – what is the meaning of life? Why am I here? But for most questions, we believe there are answers to be found. Are we alone in the universe? We don’t know right now, but the odds of that are astronomically small given the size and complexity of our universe. Scientists struggle with questions every day. Indeed, many people form careers around asking questions and then searching for the answers, sometimes to succeed, sometimes to fail, sometimes to discover things they didn’t even know they were looking for. 

But when we ask questions of our medical professionals, we don’t generally expect to hear, “I don’t know,” in response to those questions. It’s not that the professional in question is incompetent, ignorant, or behind the times. It’s just that despite our amazing leaps in technology and medical science in the last century, there is simply so much that we don’t yet know about how bodies work. Medical researchers are some of those scientists that can spend entire careers seeking the answer to questions that have yet to be answered. 

Yesterday I had the difficult conversation with my reproductive endocrinologist about why all three of our IVF attempts failed. The short answer is, he doesn’t know. That’s horribly unsatisfying, and tends to leave me feeling very powerless, but it’s the only concrete answer that we have at this point. We just don’t know. 

Certainly there’s a hypothesis or two. The apparent problem is that my uterine lining was just never able to grow robust and rich enough to support implantation of the embryos. So that’s sort of an answer, but it’s also a question. Why? What’s wrong with my lining? We don’t know. Current practice has the doctor measuring lining thickness via ultrasound, examining blood flow on ultrasound, and measuring hormone levels in the bloodstream. They can, and we did, biopsy the lining to inspect it microscopically to look at the progesterone action and apparent health of that tissue. But what makes a lining sufficient or competent to support implantation? We don’t know. It’s being studied, there are some additional tests of questionable predictive value that can be performed, but still we don’t know.

So we have established that the proximate cause seems to be an insufficient quality of the uterine lining. But why is my body that way? I had some chronic inflammation of the lining that we addressed with multiple rounds of antibiotics late last summer and fall. Could that have existed for years and damaged it? We don’t know. Last summer during my hysteroscopy he found a minor sub-septate formation in the uterus which he repaired. Was that an indication of other poor uterine characteristics? We don’t know. My uterus has been described as somewhat small, is that a contributing factor? We don’t know. Did all of these factors combine and lead to failure? We don’t know. Have I, seemingly ironically, concerned myself with birth control over several decades and never really needed it? We don’t know.

We don’t know. Probably one of the most unsatisfying sentences in the English language.

My doctor seemed genuinely distraught that we were unsuccessful. I feel very fortunate to have been his patient. He took a very personalized and dedicated approach to my case. He did extra research, consulted with peers, and made every effort to bring about the best circumstances that he could – but we only had 5 embryos that were used in 3 transfers – and we simply “ran out.” His compassion and efforts went so far beyond what most reproductive clinics would have done. That we were unsuccessful would not prevent me in any way from recommending him to anyone that needs reproductive assistance. I truly believe he’s one of the best in the country (Dr. Tamer Yalcinkaya – Wake Forest Baptist Health Center for Reproductive Medicine).

So - what I do know, is that any further attempts to have children would be unaffordably expensive. We could continue to spend money on donor eggs, try to hyper-dose me with hormones to build my lining further with each subsequent cycle. I’m not sure my mental health would survive that – hormone levels that are 10 and 20 times higher than normal are not a pleasant experience. The Man has said it would probably drive him to drink, and that’s a big statement from him (he doesn’t, in deference to his epilepsy). We could spend even more money, obtain donor eggs and then use a gestational surrogate. We were actually introduced to one several years ago locally but a mutual professional acquaintance. Even going into a direct agreement with her (rather than going through a surrogate agency) would run the entire process upwards of $75,000. While taking a viable embryo and implanting it into a “proven uterus” such as hers would have a high probability of success, that’s money to which we just don’t have access. Going through an agency would probably add another $25,000 on top of that. Even if we could finance such an endeavor, I already owe a mortgage-worthy amount of money on my student loans from my MBA. The budget really couldn’t take it short of a Lotto win.

For many reasons adoption is off the table for us. We were foster parents on the road to adoption several years ago, I’ve mentioned that in the past, and it’s not a road we will travel again. Private adoption suffers the same barriers that surrogacy does in costs – though probably “only” half of what we’d spend on a surrogate. No – that door is firmly closed as well.

At the end of our conference yesterday we told him that we were done. It was a truth that I knew as soon as we got the final negative test result almost a month ago, but saying it out loud to him gave such a finality to the situation.

I did take in the remains of my unopened medicines and supplies. Needles, estrogen patches, progesterone oil. These items are expensive without good pharmacy and infertility insurance coverage. I asked him to please give them to a patient with crappy or no coverage, and he assured me they would be put to good use.

Ending our relationship with him, for the second time given we tried for over a year with other techniques back in 2007, is difficult. It is a chapter in our lives that has come to an end.

Now we must move forward, figuring out how our lives will play out without children. I told the Man that I’d probably drag him around the world more than we would have been able to, and he didn’t object too much, insisting only on having a decent net connection for at least some of the destinations. (Addict!)

My grief has been a rocky road. I’m back with the therapist I worked with after the nightmare, she’s pretty amazing, but it will take time. Time and some pharmaceuticals I wasn’t allowed while we were trying, so there’s at least that. I have no shame in utilizing such tools, particularly as some of my issues involve anxiety and tendencies that are likely to have been genetically passed on to me.

This time I’m not feeding my grief, I can’t in many ways, but the lack of desire to eat myself into a coma is a good thing. I seem to be channeling much of it into exercise, which is good. The hormones gave me some bloat, and the inactivity associated with some of the procedures I’ve been through led to about a 10 pound gain that I need to work off.

I still catch myself thinking about things related to parenting. I might roll my eyes at a choice of names I hear someone has made, I passed a church-based school the other day and thought about how much tuition might be. Little thoughts that I have to remind myself don’t apply to us anymore.
 

Mother’s Day is approaching, this year it’s on my birthday. I always hated “sharing” that day as a child, but this year I do feel rather cheated that we won’t be able to go out and celebrate my day without it being assumed we’re celebrating Mother’s Day. Honestly, our favorite restaurants would be packed and it wouldn’t be a great experience, but I do resent it, rationally or not. Our 6^th wedding anniversary is the following week, May 17, so I’ve suggested that we combine the celebration this year. Something quiet, inevitably. Dinner, a movie in bed, a snuggle if we don’t end up with all the cats piled on top of us.

I still can’t fully imagine what life will be like going forward. I’m thankful I’m not near as much of a zombie as I was during the nightmare, but one of the “mantras” that got me through then does apply still now. One breath, one minute, one hour, one day, one week at a time. Dealing with grief can be as much about survival as anything else. One moment is all I have to think about and get through. There will be another right after it, but I don’t have to think that far out if I can’t. Just now. Just today.

Sometimes answers come in the form of questions. I hope that someday the questions that would help someone like me will be answered. I will be grateful to the scientists who will make that possible.

Failure, Birthdays, and Sadness

It's been a bit of a rough weekend. I drove to Charlotte yesterday morning to take the Certified Associate in Project Management exam (CAPM) from the Project Management Institute. It's not a requirement for my job, but since it's part of what I'm doing, having the formal recognition of those skills would be nice. It's also an introduction to the larger Project Management Professional (PMP) certification, which I would be eligible for with about another 1000 hours of project experience.

I first took the exam last October, shortly after finishing my MBA program (and the project management elective within that). I failed - a complete shock to me, I was deficient in half of the 12 knowledge areas. I put it aside as I had my WLS coming up in November, and I finally just now got around to studying again to retake the exam. You have a total of three chances to pass the exam in the year after which you first register.

Well, I failed again. I was somewhat surprised, in that the practice tests I was taking were of passing marks - not fantastic, but passing. This time I failed five of the knowledge areas. I don't do failure well, and that I had to drive home nearly 2 hours after doing so didn't improve my mood at all.

Part of the issue, I think, is not so much the hows of project management, but the PMI terminology. Do they call this activity "estimate costs" or "estimate budget" ? Both answers might be on a question, but only one is correct.

I only have until September 12 to retake the exam if I choose to do so (for another $150) without having to pay another registration fee to the PMI. So now I need to quickly decide if I just need to make a mass of flash cards and have at it, or to give up on it. I know the fees previously paid are a sunk cost, but it really irks me to think of spending that much without any results. But I'd be even more pissed if I take it a third time and fail again.

I just don't know what to do quite yet.

Today was also a difficult day, in that it is Baby J's 3rd birthday. The realization that she's been gone longer than she was here now has been tough (she was 15 months old when she was moved). I can only imagine how cute she is now, her smile and laugh are still in such sharp focus. The day brings not the wracking, sobbing pain of the early times, but still a deep, heavy, melancholic sadness. Part of me still wants to write that book, but the other part still hurts so bad when I think of the things that went on, that I'm not sure I should put myself through reliving  it all mentally.

I know that the family that (most likely) ended up adopting her live on the other side of town. It is unlikely that we would run into each other at the grocery store - but the Mall, or Home Depot or some other places would still be possible. I can't help myself from scanning the crowds or looking closer when I see a dark, curly haired toddler. The Man says he watches the customers at his store too - though it would not be a logical place for that family to shop based on where they live. I don't think either of us will ever get over it. Whether we'll have a human (rather than feline) family of our own remains to be seen - I'm trying not to be too hopeful, to avoid additional pain, but I'm not completely ready to give up on the idea, and can only hope that my surgeon will allow me to make the reproductive endocrinologist (RE) consult after my 1 year follow-up appointment. I'm hoping to be at the bottom of their goal range by then, so the weight will have all come off.

For now, I work - I study in my new masters program (did I mention? Accepted at Georgia Southern's MS in Applied Economics program), and I try not to think too hard about it all.

I hate failure.

My Meals

Breakfast

• 3/4 cup Kashi Go Lean Crunch! Honey Almond Flax
• 1/3 cup whole milk

Lunch

• Dannon Light & Fit raspberry yogurt
• Sargento Light String Cheese

Snack

• 12 baked Scoops! chips
• 1 serving Chunky Corn and Avocado Salsa

Dinner

• 3 oz NY strip steak
• 1/3 cup green beans
• .5 tsp butter
• salad of 1 cup lettuce, 1/4 cup tomatoes, 3 radishes, 1/2 oz pepitas, 1 tbsp Ken's buttermilk ranch dressing

Water - 40 oz

Daily Totals: 946 calories, 45.8g fat, 88.6g carbohydrates, 29.3g sugars, 54.6g protein

I Was A Mother: For One Precious Year

I hate Mother's day; with an all-consuming passion. When I was a little girl, every few years I had to share my birthday (May 11) with Mother's Day, which made me feel cheated - in only the way that little girls can feel cheated by such things.

In 1992, when I was 25, I became estranged from my own mother. She's long had her own issues, but when I moved back to California from Washington and temporarily stayed with her, she transferred her anger over her own issues to me. I had plenty of my own things to deal with, and wasn't going to take responsibility for her problems (that were definitely not my problems) - so I moved out and haven't really spoken with her voluntarily since. One glaring exception was when I agreed to go to a family reunion in Kansas City, MO in 2006 - and only because both of my sisters would be there. Not really much since. There's too many additional things about my mother that aren't what this is all about, but I can't imagine we'll have anything resembling a relationship again.

After that - I spent time being annoyed at the generic "holiday" greetings thrown at people by retail or service workers; often under threat of discipline by their managers. People, please - don't throw such generic things at people. For Mother's Day - you cannot assume that every female of child bearing age or older is a mother. They may have just lost their mother, or lost a child. They may be living that special, lonely hell of desperately wanting to be a mother but for a variety of reasons have not been able to achieve that. Your generic "Happy Mother's Day" can make them anything but happy. It might just be a slight annoyance at the assumption, or you may find yourself with a woman suddenly trying to hold back sobs while putting her credit card back in her wallet and trying to make a mad dash to her car in the parking lot.

Just Don't Do It.

But for one beautiful day in May, 2010 - I was a mother. I've mentioned briefly that we used to be foster parents. Baby J came into our lives in early September 2009 when she was just 8 days old - freshly discharged from the hospital. She was the happiest, most adorable baby ever. With foster children, you cannot assume that you will have them for any specific length of time, though due to her birth circumstances we knew we would have her at least 6 months. To say that she was a delight is a historic understatement. While the Man hates photos, this one of the two of them when she was 6 weeks old speaks volumes to how we felt about her (her face is blurred, as identifying photos made publicly available were not allowed - though I think she'd be hard to identify from this photo, I won't take that chance. Those who have a Friends connection with me on Flickr have access to un-retouched photos.)

Early in 2010, as J approached 6 months old, we decided we were ready for a second child - we were licensed for two, so we told our licensing worker that we would open our home for another child, preferably one age 3 or under. 

Very shortly afterward, we got a call about a little girl T, who was 5 days shy of her 3rd birthday. I remember I was in the middle of a select luncheon at school with the former CEO of Wal-Mart -and my cell phone goes off. Out on the balcony of the building on campus I had back and forth calls between our worker and the Man, trying to decide if we should take the placement. I actually twisted his arm a bit (ironically) and we accepted. I had to return to school that night, so she'd arrived at the house about 20 minutes before I had to go - frightened, not wanting to leave the social worker that she knew, and clearly not sure what to make of Baby J, the Man, and the cats.  She crawled under the coffee table with a baby blanket and fell asleep, and wouldn't let either of us put her to bed - she slept there all night, and the Man slept on the floor with her. 

T arrived still in diapers, barely verbal, and with that dead, 1000-yard stare you see in shell-shocked soldiers, not something that should be on the face of a barely 3-year old child. We advocated fiercely and frequently for her, but very few of our concerns were addressed. By the time she had an early pre-school intervention she'd been with us 5 months, and had actually grown into quite a chatter box - though her enunciation and diction still needed more work than a developmentally typical 3.5 year old. 

So Mother's Day 2010 I was actually a mother. If anyone said or says to me I was "only" a foster mother, I'd have shanked them. No, these girls were not mine by blood, and not even mine legally except through temporary guardianship of foster parenting, but I was their parent. The Man bought me a beautiful card "from the girls" that talked about being Mom had nothing to do with DNA, but instead was about love. I cried. While I was slightly annoyed I had to share the day with his mother (something I had previously expressed not wanting to do) - in the end it didn't matter, we got to celebrate Mother's Day for me. 

T blossomed over the summer, but as she grew more comfortable with us the issues that were brought about by her background continued to come to the surface. We were continually dismissed in our requests for her as being inexperienced parents, or that she was "just 3" - both of which were true, but were not the root cause of the problems we were trying to solve. As fall came around, things just devolved. We gave it our all - we were committed to T, willing to go the long haul with her, but we weren't getting any support, and were specifically forbidden to seek some help we had been asking to be given. 

It came to a head in November in a way I won't describe here now - as I mentioned at the beginning of this blog I am still considering writing a book about it, but there's too much to it for a single blog post. On one awful night, the decision was made (by others) to move T from our home. In doing so, they chose to take J as well. We were heartbroken. J's case had progressed to the point where parental rights were being terminated, and we were in the very early stages of working to adopt her. She was 15 months old, and we were the only parents she had ever known. 

What happened afterward is an experience I'd not wish on my worst enemy. We spent months and thousands of dollars trying to regain custody of J, but in the end were blocked at every turn. Our relationship with our local social services agency was irreparably damaged. We were no longer parents, and were not going to be parents again in this way.

Mothers Day 2011 was beyond painful. We had just effectively come to the end of fighting for custody of J, the Man's mother was dying of cancer (she would pass a month later on June 8), and I was struggling to finish the last year of my MBA program. I think I probably did shoot daggers at many people who gave me that crappy generic "Happy Mother's Day" - I was no longer a mother, and it stabbed me through the heart every day. The girls' room had the door closed - like this black hole of grief kept at bay only by this small wooden barrier. I had to take the portraits down off the walls of the living room and the hallway - they were hidden away in that room, I couldn't bear to see them. 

As I began my weight loss surgery journey, Dr. Fuzz told me that he wanted all of his pre-menopausal female patients on birth control, as those with fertility issues often had their fertility come roaring back, often very soon after surgery. I rolled my eyes at him, but agreed. I didn't expect a positive response, but I also asked if he thought fertility might come back, would he consider allowing me to attempt an IVF perhaps a bit sooner than the 2 years they want most patients to wait - after all, I was 45, and at that age, every month counts. 

Fuzz told me that if I complied and got into my goal range, he'd consider approving my working with the reproductive endocrinologist again (we'd tried multiple rounds of injections without and with IUI in 2006/2007, but stopped short of IVF due to lack of funding at the time). I'm still 30-odd pounds above the top of Fuzz's goal range for me, but when I have my 6-month follow-up appointment with him on May 31 it's something I'm going to bring up. I just had another Depo shot the other day, so it will be a few months before that wears off, and any IVF attempt takes months of prep - I want to coordinate all of that appropriately. 

While I cannot yet bring myself to fully believe that this will be successful, I cannot walk away from the possibility of one last attempt at being a mother. Despite all the trials we went through during that time, and despite the horrific ordeal afterward, it was something that I desperately want to have in my life. 

Now in 2012, this Mother's Day is a year of transition. the Man's mother is no longer with us - something we'll definitely miss. I'm desperately trying not to eviscerate people who spout the generic Mother's Day crap. And finally, of course, I'm recovering from a month of hell with the fissures and surgery. I'll be doing my best on Sunday to ignore everything about Mother's Day - but I can't help but have that tiny bit of hope in the back of my mind that perhaps at this time next year, we may be expecting a child of our own. I can't believe it, but I cannot give up. 

I was a mother - for one precious year. Please, universe, let me be so again soon - for the rest of my life.