Happy Endings

My grandmother, age 19, 1932

My happy ending is not going to be what I thought it would be.

I still don't know what's in store for us: what portion, if any, of our parenthood journey remains to be travelled. Perhaps a baby from Jody's body will be in our arms one day. Perhaps a toddler will run through our house after exiting the foster system. Or, maybe the only little feet padding on our floors will be of the four-legged variety. I don't know. Maybe my happy ending is simply what I've already got; it's just not what I've been imagining for the last 42 years.

I have been so focused on the goal of pregnancy for more than two years now that I haven't truly tried to imagine my life without children. It would have been counter-productive. So here I am, closing the door on what I'd said would be my last attempt at a pregnancy, and trying to "go there" in my head.

Subconsciously, over the years, I have socked away experiences and lessons learned, parenting moves I disagreed with, childhood memories I wanted to recreate (involving the purchase of several seasons of The Carol Burnett Show, The Mary Tyler Moore Show, and M*A*S*H)...all with the expectation that one day I would use this information as I raised my own kid(s). What do I do with it all if there are no kids?

My wandering thoughts return to the spring of 2007, as my Nan lay dying at her nursing home in Markham. It was my first experience of being with someone throughout the process of dying, and I still feel it deeply.

Holding my grandmother's hand in the nursing home  ©Shutterbug

My grandmother suffered from dementia, and had in many respects left us long ago. What remained was the love, and I will never forget coming to this realization. She existed in the same state for several years, our visits consisting of gentle hugs with her frail body (which still brought such warmth to my heart), repetitive discussion of the weather, or the day's meals, and mindless television programs (often golf, a game she'd enjoyed playing for most of her life). And then, one day, she simply stopped eating. There was no rhyme or reason, we think she just decided she'd had enough - and who could blame her? This is the woman who, widowed unexpectedly at age 58, proceeded to travel with friends and take up new hobbies with abandon. This is the woman who, at age 68, accompanied us on a family trip to Disneyland, and gamely rode every rollercoaster with me. And this is the woman who, at age 69, decided to remarry and move across the country to begin a new life in Victoria, BC. Eighteen years of travel and adventures later, she found herself widowed a second time, and it soon became clear she was no longer able to live in the retirement community that had been their home. She was unable to find her way to the bathroom in homes she'd been in a hundred times before, and once in the bathroom, often didn't know what to do. She didn't want to be here anymore, and we would have to let her go.

My Nan sang her way out of this world. Music always played an enormously important role in our family, from my great-grandmother providing the piano soundtrack in silent movie houses, to my grandmother and her sister singing on the radio, to the whole family doing dishes in the kitchen and everyone singing their own part in perfect harmony. Nan's arthritic hands could still bang out a mean tune on the piano in her 60s, which spurred my interest in lessons as a child. At holiday gatherings, any member of the family could burst into spontaneous song in the middle of a conversation, if a word sparked a musical association. It was not only tolerated, it was encouraged.

As she lost her command of language, my grandmother began to sing her side of every conversation. Eventually this dwindled to her belting out just a few specific songs that had lodged in her foggy memory, one of which, for some inexplicable reason, was "God Bless America". You'd ask her a question, she'd smile, and answer in full-throated ninety-three-year-old song "GOD BLESS AMERICA, MY HOME, SWEET, HOME" in perfect pitch.

She began to disappear, to shrink from her already-frail state to someone I barely recognized. Her teeth began to fall out, which she handed to us with a confused and slightly irritated expression on her face. She began to sleep more, and exist in an in-between state, muttering things that made sense only to her, then pleading with us to "please let me go". My aunt flew in from Seattle to join my mother and uncle at their mother's bedside. We each took turns sitting with her, talking, reminiscing, and, of course, singing. I stroked her hair, and rubbed her feet, and told her that I loved her, feeling as though life absolutely comes full circle. Living with her until the age of 7 as I did, I could only imagine the number of times she did all of those things for me.

My grandmother holding me, summer 1971

I went to work sporadically, none of us sure when her laboured breathing was a sign, and when it wasn't, and spent a lot of time just sitting with her and thinking. And watching. Watching her three grown children, two of them now also seniors themselves, care for her so lovingly and do whatever they could to ensure she was comfortable. I remember thinking to myself that she had raised three (and a half) pretty wonderful people, and you could feel the love in the room. Nothing else mattered, and it felt like I was finally grasping something. Whatever money and possessions she'd had, wherever she'd gone, whatever she'd done...all that mattered in her last days was who was with her, sending her on her next journey with love. I felt the need to build my own family more keenly than ever.

She died on my 37th birthday. I woke in the early hours of the morning with a start, and an overwhelming desire to drive to Markham to be with her. When I left her side the night before, I kissed her head and thanked her for everything she'd done for me, and there was nothing left unsaid. Now I fought the urge to get dressed, drive to the nursing home, and lie in bed beside her, telling her it would all be okay. I talked myself out of it, worrying that it wasn't my place, that the practicalities of getting in there were too much, that I was being dramatic. At 6:00 a.m. the shrill sound of my phone woke me, and my mom choked out the words, "She's gone." I raced to the nursing home and waited in the parking lot for everyone to arrive. We sat with her for hours, holding her hands and feeling the warmth eventually leave her body. I watched as people finally wheeled her tiny shell away, the smallest bump I could imagine under the sheet.

What scares me is envisioning those scenes for myself one day, but alone. What if I outlive my spouse, and we have no children? What will bring me comfort in my last days, months, or years, by myself? What is the point of all the things I've worked towards, and all the dreams we had for our lives, if there is no one to share them with? Or what if Jody is the one to outlive me, and my beautiful, gregarious, wife is sitting alone in a home one day?

I am a photographer who has been cataloguing her life for years. I began a project to amalgamate all the beautiful historical photos I inherited upon my grandmother's death, and create a lasting record for all the members of our family. Suddenly all of this became so much less appealing at the thought that it's only for my own benefit, with no one to pass it on to. All my things, all my memories, will one day end up in a dumpster or some curio shop, like the many sad, dust-covered belongings I've poked through in similar shops over the years.

If family is everything, what does it mean when you cannot have one, through no fault or choice of your own?

And there is that. This is not my fault, and yet I feel as though I have failed. I have lost two more little lives that had actually begun, and taken root in my heart. I couldn't keep them here, and everything we've been through has been for nothing. All the needles, all the tests, all the pain, all the stress, the heartache, the money...has all been for nothing.

I don't know where we go from here.

Two

Ultrasound showing two spots of light floating in my uterus

We were never given one of these lovely ultrasound pictures when I was actually pregnant, so this is a first for us to hold some physical proof in our hands. This has suddenly transitioned from surreal to very real.

The last 4 days have been incredibly stressful, emotional, and tiring. Surgery on Friday, then waiting to hear what the final egg tally would be for this journey; the interminable wait on Saturday for the call to tell us what was happening with the eggs; the long wait on Sunday for the call to say if the two fertilized eggs were still dividing; to today, and having the actual embryo transfer done.

We were of course on pins and needles this morning, wondering whether something had happened in the last 24 hours to our two promising little embryos. I was taken to a back room to change, and wait for my procedure, so I new we must still have at least one to work with. We tried, as always, to prepare ourselves for any eventuality, but it's impossible to keep going without a heart full of hope.

Waiting/recovery area at Mt. Sinai   © Shutterbug

It was a very long wait with a very full bladder, since the embryo transfer is guided by an abdominal ultrasound. We were told Dr. Greenblatt would be doing the transfer, but this was wrong again - it was the team of Dr. Garbedian (we love her), and Dr. Arthur. She was even warmer to us today than she'd been on Friday, going so far as to put her hand on my back as she saw my eyes welling with tears during our walk down the hall. She said some reassuring things about it being straightforward, and that everything looked great.

Back in the procedure room (the same cavernous place where Patricia had butchered me in January), Dr. Arthur ran the ultrasound wand across my stomach and confirmed everything was fine. The embryologist came into the room with the lab report, which showed that one of my four original eggs was too small to perform the ICSI on, and was lost right away. One had ICSI but then failed to fertilize, and the two fertilized embryos were now 7 and 8 cells. She said they would both be graded "A" (I felt a small rush of pride in my 40+ body, like a student who turned in a great paper), and that things couldn't look any better. We were giddy with this uncommonly happy news.

The last step was for the embryologist to examine the embryos' shells, which they decided were a bit thick (a common age-related issue), and said they would benefit from the "assisted hatching" procedure: thinning a small area of the zona pellucida with a laser, to help the embryos actually emerge, and implant in the wall of my uterus. Who knows, perhaps this one small step was where the problem lay all along with our previous failed cycles. All we know is that we have done everything humanly and scientifically possible to make this happen.

Jody and I were both able to watch on a monitor as they guided the catheter into my uterus, and released the two little bright spots of light that are, for now, our children. They even took the catheter back to the lab for microscopic review to ensure that neither embryo had floated back into the tube when it was withdrawn. Dr. Arthur pointed out the landscape of my body on the monitor, and said the two spots now looked like one because embryos "like to stick together". I am suddenly deeply in love with both of them. I want them to have each other as they grow. Once my greatest fear, twins are now the only acceptable outcome. I can't lose either one of them.

Dr. Garbedian gave us each a big hug and wished us well, saying with a laugh that she hoped she never saw us again. We said we hoped she had the magic touch. Dr. Arthur was smiling, we were smiling, and I was told that I was now officially "PUPO": pregnant until proven otherwise.

Holding two views of my two embryos  © Shutterbug

For the first time in six months, my wife kissed my belly again today, and told our babies to stay put and stick. This has to work. I need to feel her love for my belly on a daily basis for the next nine months.

And we are already considered to be three days into our two-week wait.

TTC - The Final Frontier

At Mt. Sinai on the day of reckoning, March 9, 2012  © Shutterbug

It was never my intention for this blog to get bogged down with our infertility troubles, but it's taken over our lives. It IS our lives. 

The struggle to maintain some sort of perspective on the whole process continues. There are times when all you can do is laugh, and times there is nothing to do but cry. Sometimes my wife and I do both.

Our last IUI (converted IVF cycle) was another dismal failure, followed by having to hastily decide what to do next. Obsessive Googling produced conflicting opinions on whether injectable fertility drugs have cumulative benefits, or whether it was better to give your body a rest between cycles. We decided to go with our guts and our fear of my now-gonging biological clock, and just go for it again.

Another early morning trek to the clinic for another Day 3 scan, with the unhappy news that I had not one but FOUR significant ovarian cysts, which meant that cycle was out of the question. Interestingly, my feelings of frustration and angst over the wasted cycle were alternating with a feeling of relief at not having to think about it for a month. We slept more, exercised more, and lost a few pounds.

We were told to meet with Dr. Liu for a review, and she said there was little point in raising my already very high dose of medications. She increased the Menopur from 75iu to 150iu, but said anything beyond that was "just a waste of money". We asked if this time we could choose to proceed with the IVF procedure regardless of the number of eggs there were, and she said yes. We knew there were clinics out there with women who prayed to produce just a single egg, and had success. We still didn't know where we would draw the line, but at least we would be in control of whether to move forward.

This time around I was expecting the uncertainty, and didn't look for too many answers early on. My Day 3 scan showed six follicles and no cysts. My wife and I trudged down the hall to the billing office, and plunked down a few thousand dollars more for the vials of medication. 

So began the mixing and poking and bruising and bloating and headaches and depression. We still counted the days to scans, but I wasn't losing sleep over it as I had before. By Day 7 we knew I had two strong follicles on the right and 1 on the left, which was the most we'd ever had to work with.

Scans and blood work followed on a daily basis, and I added injections of Cetrotide to the other medications. Each day they told us to wait until they called with the blood test results, which contradicts the prescription information that the injections be taken at precisely the same time each day. There is no returning the meds once they are purchased, which at $750 per day is no small investment. So we bite our nails waiting for the call, then rush around trying to fill the prescription, then inject me as quickly as possible. But be sure to cut down on your stress, ladies! On Day 14 we found out a fourth little follicle had suddenly decided to join the party, and might be big enough by retrieval day. Wow.

Thank God we both have a good sense of humour and can laugh in the waiting rooms. We observe lots of really odd behaviour, we laugh at frustrations like long, loud cell phone conversations, and we watch newbies find their way around. We are greeted by name by all the staff, who often stop to chat with us. Our fertility clinic has become like our Starbucks, or local pub. Sad, really, because we never intended to be there this long, and yet there is a level of comfort in knowing all of these people are truly pulling for you.

I took a Cetrotide injection the night of Day 14, so it was shocking to get a call from the clinic after the next morning's blood work to say my LH levels were still rising. We had to drop everything, leave work, and rush across the city to pick up an emergency second dose. Ovulating through this medication and missing the egg retrieval would cost us $14,000, and there are no funds to try again. This is it.

Day 16 was show time, and I barely slept. I passed the hours between 2 and 6 a.m. watching reruns of The Golden Girls and home improvement shows. Thank God for extended cable packages. We were at the clinic by 8 a.m. and had an hour to prep before the procedure. The nurse, Theresa, carefully evaluated all of my veins, including using a tourniquet in various locations, before deciding to use my hand. I am resigned to being a "difficult case" now after having been labelled this by so many sources. Difficult veins, difficult cervix, difficult ovary...I can only imagine what my birth experience would be, should I get there.

Difficult veins  © Shutterbug

Jody in the waiting room with booties  © Shutterbug

We'd been told that our favourite nurse Maddie and Dr. Liu would be doing the egg retrieval, but this was not so. It would be Theresa and Dr. Arthur...the dreaded woman who had done my pregnancy ultrasound before my miscarriage, about whom I'd sent in a written complaint. This woman would now be in charge of the most important procedure of my life? Theresa saw the look of horror on my face and went to find an alternative, so it turned out that Dr. Kim Garbedian would be doing the retrieval with Dr. Arthur there to supervise.

To be fair, Dr. Arthur was friendly and professional and showed no sign of remembering us. However, the first thing she said to me as I lay on the table was, "I expect this to be a difficult retrieval, because your left ovary is high." Of course it would be.

The drugs that were supposed to put me in a "twilight state" certainly made me feel calm and slightly swoony, but did nothing for the pain. Nothing. I remember every moment of the procedure, and as the stabbing pain of them puncturing my ovary hit me I begged for more meds, which they apparently provided. Once again there was a lot of blood, enough that it splashed on the floor and on the doctor's gown. This is not supposed to happen.

They managed to get four eggs out. It was the best possible outcome we could hope for, and I was really proud of my wife and I for not giving in to the doctors' pessimism about doing IVF. It only takes one, and we had four. In my obsessive online research there are many clinics with women praying for just one or two eggs, and we had double that.

I was sent home a couple of hours later, and spent the remainder of the day in bed. I was surprised to find this much like other surgical recovery, in terms of abdominal pain, bloating, etc. It was another sleepless night, and a fairly unpleasant day today too while I recovered and waited for the phone to ring.

And ring it finally has, with the news that two eggs have definitely fertilized, and a third is still a possibility. The fourth one is lost, for whatever reason. My body did the best it could. It's hard to wrap my head around what's going on in a lab downtown right this very minute. It's hard to restrain myself from running down there to press my face against the glass of the lab, and watch and will a petri dish to grow our children. We imagine every scenario, every outcome, and have already begun the anxious waiting for tomorrow's call.

I hear the excitement and job in my wife's voice, and it is oh so contagious. Even my normally reserved mother told me to cherish this milestone, and be happy for what we've achieved thus far.

Come on, give me another shot at this.

Are you there, God?

(c) Shutterbug

For a non-religious person, I sure have voiced a lot of little prayers over the last four weeks to an entity I don't think I believe in.

My life has changed so dramatically with my new/old job; there is no time throughout the day to contemplate my situation, or obsessively Google the week of my pregnancy, and my every worry. And there is now reason to worry.

We counted down the days to our first ultrasound this week, at exactly 7 weeks. We went to bed thinking about our baby, and woke up thinking about our baby. We watched videos of embryonic development, envisioned what was going on inside of me, and wrote notes to our future baby.

The ultrasound at Mt. Sinai was the typical clusterfuck. It was slated for the morning of Friday, September 23: the date we considered our anniversary prior to our marriage, since it was the night of our first date. We took this as a good omen. I booked a vacation day, and scheduled an additional medical appointment for the afternoon to maximize my time off. Then Mt. Sinai called to reschedule the ultrasound to the day before, requiring juggling, then called twice more to change the actual time of the ultrasound. It was finally set for 8:15 on the 22nd with Dr. Liu.

We arrived to face the usual packed waiting room, which conflicted with the nurse's explanation that my appointment was moved up twice to eliminate large gaps in appointments, seeing as how there "weren't that many". I checked in at the desk, letting the receptionist know I was here for my pregnancy ultrasound with Dr. Liu, and was informed that Dr. Liu was away at a conference. Say what now? Apparently Dr. Rebecca Arthur would be filling in, and we were directed to the same change room/waiting area as is used for cycle monitoring. The half hour wait annoyed me more than usual after the specific direction we'd received to be there earlier. Eventually a staff member moved us to the same old hallway outside the same old ultrasound room. My wife noticed there were spouses attending for the first time, so it became obvious that all of us waiting here were already pregnant, and not just the women having cycle monitoring scans. 

As the first couple went in, then emerged a few minutes later, I turned to my wife and said how inappropriate I thought it was to have the rest of us sitting directly outside the room. To say there was a lack of privacy would be a colossal understatement. What if someone received bad news? As soon as those words were out of my mouth, nurse Maddie came out and asked the couple behind us to return to the other waiting room until she came to get them. When our turn came to be led into the ultrasound room, there was no one else in sight. Our moment of truth had arrived, and my heart was beating out of my chest.

Dr. Arthur was waiting at the foot of the exam table, barely visible in the dim light. She asked if I had had any pregnancy symptoms, and I replied that I had increasing fatigue and heartburn, along with some minor cramping that had come and gone since day one. She prepared me for the test as if reading from a page, saying she would insert the ultrasound wand and then would be silent until she was sure of what she was seeing. I was nervous, scared, excited, and still wanting actual confirmation that I was actually pregnant - in addition to confirmation that there was just a single embryo in there! I wasn't sure what they could tell me this early on.

Dr. Arthur's silence stretched on, and on...and on. She moved the wand, pressed it to one side, pressed it to the other side, moved it some more, pressed some more, and squinted at the screen. My nervousness reached a fever pitch, then grew into a hard knot in my stomach that began to sink as it became clear something was wrong. Nurse Maddie stood up and walked around behind the monitor, looked at the monitor with Dr. Arthur, then they looked at one another, and then Maddie returned to her seat beside my wife, who was beside me. Just as I felt like I was going to scream, Dr. Arthur began to speak.

What she actually said is now a garbled mess in our brains. She used the words "abnormal", "reason to be concerned", and mentioned the proportion and amount of space. She confirmed she could see a "pregnancy sac", at which point my wife asked about the size of the embryo, and Dr. Arthur said it was what she expected. We weren't understanding the problem. The doctor herself admitted she wasn't exactly sure herself what she was seeing, and wanted us to go to the hospital in a week's time for another ultrasound. What?!?! She said it was just too soon to tell what was going on, which made me incredibly angry. Clearly she suspected something, but she wasn't saying.

There was a roar in my ears, and her words just kept repeating in my head, making it hard for me to formulate any questions. I finally asked whether she saw a heartbeat, and she replied that she saw "a flickering". What does that mean? She was giving us nothing to go on, and we were being ushered out of the room. Maddie briefly grabbed the back of my hand and squeezed it as she handed me my progesterone prescription, and told me to continue taking it for now. It was the only sign of compassion in the entire appointment.

We left in shock, and drove home in silence. Eventually we cried, ranted about our ongoing frustration with our medical care, and Googled like fiends at home. But there is no magic website that can tell you about your own unique situation, you can only read about how things turned out for other people. The outcomes range from miscarriages, to women talking about their now-toddlers that doctors had told them didn't exist.

With a day's perspective, our sadness and confusion gave way to rage and frustration. Anger at the slew of doctors with no bedside manner, the lack of individualized care, and lack of information. There was no way I wanted to go back to Mt. Sinai at this point, and no way I thought I could wait an entire week for any further news. I called my GP, who scheduled an ultrasound for me at her hospital, but it is still four days away.  In the meantime, there has been no call from Mt. Sinai to confirm the ultrasound Dr. Arthur apparently ordered there. There has been no offer of care whatsoever. I don't know what I expected, but I feel like a number with no relationship to anyone. 

And as today wears on, there is a dull ache beginning in my midsection. I just feel unwell, and for the first time in seven and a half weeks, a trip to the bathroom showed some spotting. 

I fear the worst, even as I sit here praying for the best.

TTC - The Final Countdown

"Aunt Flo" arrived right on time this month, just as she has every other month for as long as I can remember. Trying to keep one's expectations low means less opportunity for crushing disappointment at this news, but results in more of a constant, low-grade depression.

Last month was not the first time I told myself it would be the last time I would suffer the pain, inconvenience, and indignity of all the requisite fertility procedures. I said I needed a break and I meant it, but when my seemingly inevitable day 1 arrived, I had to make the choice of whether to call it into the clinic or not. Suddenly I began to feel anxiety at the thought of taking a break instead of relief, envisioning one of my poor little eggs making its journey with nothing there to meet it. This is the reality of being in a same-sex relationship: there will be no happy accidents. It would be another lost opportunity; the slimmest of chances that this will be the month. And so I called it into Mt. Sinai, as I have so many times over the last year and a half.

My day 3 ultrasound fell on a Saturday, as so many of my procedures do, and the Mt. Sinai clinic was packed. My appointment was strangely late, at 9:00, and we could barely find seats in the waiting room. We were uncomfortably close to those around us; two couples who had each shown up with needy toddlers. A woman across from us recognized an older gentleman sitting nearby and proceeded to have totally inappropriate, top-volumme conversation with him about what he and his partner were going through. He took pains to be polite, giving ever-shorter answers to her barrage of questions ("So, are you in the middle of IVF?"), but soon appeared to be completely absorbed in his child's video game as a means of avoiding the interrogation. Some people have zero ability to read others, and zero filters.

A very tall, large, and intimidating black woman appeared in the doorway, swinging her long braids and demanding to know who was still waiting for blood work. She then began pointing at people, stabbing the air and grunting, occasionally demanding to know their names. "YOU!" she would yell. "BLOOD?" she demanded, scowling. When she came to me and heard I needed bloodworm, she grunted and pointed at the hallway, which I had to assume meant I should follow her. She didn't smile, and didn't talk other than to point at the computer screen and say, "That you?". Bracing for the test, I was unsurprised when her painful jab missed my vein. While pulling the needle in and out of my arm, changing the angle of entry to spear the uncooperative vein, she finally asked, "Does that hurt?". I was practically in tears, but had to laugh as I responded with What do you think? Once I was done, my wife and I proceeded to watch as she repeated this exchange with other people. How did this woman ever get her job? Surely you still have to interview and be chosen in the medical field, just like with any corporate job? Or as a nurse are you simply given assignments? Does no one care whether you have the shittiest job performance imaginable? There doesn't appear to be any accountability at Mt. Sinai. How could there possibly be so many incompetent people, month after month, doing a bad job with an even worse attitude? It crossed my mind that it was a teaching hospital, but these people were far too old to be students, and there was certainly no instruction going on that I could see.

This ultrasound was our first introduction to Dr. Rebecca Arthur, who we'd been told would be taking over our case during Dr. Liu's mat leave. She seemed nice enough, and spoke with confidence. When I asked about the follicle count, she told me not to worry about it from month to month, as it would probably not vary much given my age and test results (FSH/AMH levels). I think she said there were four this time. I asked about alternative drugs, since I was feeling like the Clomid wasn't having much effect, and she said injectables were an option for about $1,500 - but would likely not have that different a result. What?! I couldn't really process that news. Wasn't that the next step for an actual IVF procedure? Wouldn't those be the "big guns"? She offered to up my Clomid dose to the maximum 150mg to see if that helped, and we agreed to go with that.

This time the side effects included the usual fatigue, increasing mood swings and bloating, but also threw in some new insomnia, daily headaches, and daily nosebleeds. All this, and yet know that it's important to maintain a positive, stress-free environment for yourself to maximize the chances of conception. 

As I go about my daily life, I can't help but wonder whether anyone has used fertility treatments as a reason for actions of temporary insanity in court.