Thursday, April 28, 2005

Say what?!

Surely they can't be serious?

Three days after receiving the heinous, hideous denial letter, this was in today's mail:

"The Clinical Coordination Department of Blue Cross Blue Shield of Massachusetts, after careful review, is pleased to inform you that the request for service(s) made on your behalf has been approved.

Place of Service: Doctor's Office

Type of Service: IVF


At this time we approve medically necessary services for a total of 3 (days)(services).

If it is medically necessary for you to receive services beyond 9/25/05, your provider should contact Blue Cross..."


Unless I am reading this wrong--am I?!--they have decided to reverse course and approve the IVF. This letter does not make any reference to the ICSI, but, by gum, it sounds like we won't owe the whole kit and kaboodle, regardless. (And what's the going rate for a kit, with and without the kaboodle? I heard a rumor that the kabbodle is about $1500; a much less scary proposition than paying also for the kit.)

This piece of (apparently) good news abruptly made the world seem so much prettier and cheerier and sunshinier...


 Posted by Hello

...that I wished I could go back to Bridalveil Fall and take the picture all over again, since I couldn't properly appreciate it at the time.

. . .


On that National Parks note, we are heading down to L.A. for a friend's 40th and to celebrate the 1st and 16th birthdays of two of my nieces; then, on the way back, we plan a detour to see Joshua Tree. Hear the torrential So Cal rains have created a wildflower wonderland out that direction, though it may be a little late in the year. Regardless, we will almost certainly take several hundred thousand pictures of oddly-shaped, spiny tree-cacti and bore you silly with them upon our return.

Wednesday, April 27, 2005

Mui ridiculo

This depression thing is getting a bit silly. I have spent the last two hours playing the melancholiest piano works by none other than that consumptive force of gloom, Mr. Frederic Chopin. I selected precisely nothing in a major key, and nothing with a pace above largo. Finally stopped when I realized I was halfway through the goddamned Funeral March.

(Even if you don't know that you know the Funeral March, you do, in fact, know it. It is the melodramatic music of doom in every Hanna-Barbera cartoon. Dum, dum, da-dum, DUM, da-dum, da-dum, da-dum. )

It's one thing to allow myself to really feel this sadness, but it's another thing to wallow in it like a thick, stinky mud bath. To borrow my beloved grandmother's favorite expression, which she picked up as a seventy-year-old living in Guadalajara, it has become mui ridiculo. Just ask the neighbors, who shut their windows about halfway into my performance.

. . .


As of this minute, my mental state appears to be on the upswing: I just rediscovered my appetite, which had been hiding out in the adrenal gland control room for a week or so. This, I am remembering, is how I used to stay so slim, back in the bad old days when I was unreasonably unhappy. Since then I have added several Jeff Pounds, as I like to think of them. The Pounds of Happiness.

Guess I'll make room for a few more; after all, we have three kinds of cheese, good sourdough and an apple pie for dinner, and that's worth a least a few millimeters of extra rumpage.

Tuesday, April 26, 2005

Can I borrow a cup of anger?

That Depression, she is not very kind. She turns my face to stone, makes me hide under the covers in my dark room. She has sapped all of my energy. Worst of all, she has gutted me of my anger and indignation.

How can I cope without them? They are what was holding up my spine, the legs of my forward momentum. Anger with my body, indignation with life's rank unfairness: they gave me force. Even the force of negativitiy has a price beyond rubies when you have nothing but sadness and inertia, and quiver like gray Jello.

Perhaps she will allow a few electric anger surges to penetrate the wobbly gloom in a day or two. Please, Ms. D. Please.

Pretty please?

Monday, April 25, 2005

Aftermath

There is not much more to say. I have not found any silver lining; I haven't been able to dredge any humor from my heart; I have not found a distraction from the failure, the loss of hope.

The pain is compounded by the unexpected shock of our insurer's refusal to cover the procedure, even after our doctor submitted a letter of medical necessity. We received the official denial upon returning from Yosemite.

Jeff's sperm is not adequately abnormal for them to approve the ICSI; I may or may not have been sufficiently diagnosed as broken in advance to qualify for the IVF at all without three FSH/IUI's. Now that I am designated a poor responder, and the decision to do IVF with ICSI, though unsuccessful, was clearly the right call for our paltry harvest, the insurance company says that it doesn't matter--that the diagnosis can't be made in retrospect. None of their abstruse restrictions were made known to us when calling to verify coverage months ago. There are appeals processes, but it seems hopeless.

I am trying to keep it together, I am trying to stay calm, but I'm failing. Oh, god, how I am failing.

Thursday, April 21, 2005

Next

Before we started this last cycle, Jeff and I tentatively agreed that we would give it two more tries and then call it a day. We had (or thought we had) the coverage, so why not give it a go? After three, we would start to look seriously at adoption. But that was miles away, miles and miles.

After the first week of stims, in that hyped-up, ripening state, I thought the plan feasible. Three seemed like a good cutoff.

After that first follicle count showed just six, and I had gotten over my first meltdown, I thought, it's hard, really hard, but I can do this at least one more time. Maybe not twice, but once, for sure.

After they retrieved just four eggs, I wondered, can I really handle this disappointment again? Maybe. Probably. I think so.

After the call came yesterday, I thought, very simply, I am not pregnant. I didn't say to myself, I will never be pregnant. I thought, devastated as I am, I might be able to do it again.

After the meeting with Dr. Katz this morning, when the words "poor responder" were officially added to my file, and after he said I could try a microdose protocol next time, and not to give up on my own eggs yet, something snapped. Pregnancy, no matter how many cycles I do, is now just a chance, not a probability.

I don't know if I can do it again. The physical part is certainly uncomfortable, but so easily forgotten. I could handle that over and over and over, as often as needed. Seeing my body's failings unfold, and living with the arc of those pendulous, swollen disappointments, though--these I cannot take in stride. I am battered, I am torn up, I am filled with pain. The best I can do may be a grudging, eventual acceptance that does not contain any hope. Will that will be enough to propel me through another cycle?

I don't know. I just don't know. Perhaps it's too soon to know.

For now, I cry, and try to care about something in the world that isn't the one thing I can't have. I'm not succeeding, but I'm trying.

We are deeply indebted to you for your beautiful comments and unfailing support. I read some of them to Jeff, who promised forever ago never to look at my blog and has kept his word. We were both moved to tears by your thoughtfulness and compassion.

Tomorrow morning, we will drive to Yosemite to recuperate for a couple of days. We realized today that it's our anniversary; we spent our brief honeymoon there, five years ago, and I am afraid of tainting the memory with our current misery. But perhaps it will help us remember life's grandeur and scale, and not its small, condensed sadnesses.

Wednesday, April 20, 2005

Debt

As we walked out of the lab after this morning's beta, Jeff held my hand and said, "Maybe it worked. Maybe it didn't. I love you."

I started to reply with the automatic, distracted, "I love you, too," when I was struck in the gut by the force of it. It is the most powerful force in my life, stronger than my will or even my self-interest. I love him more than I love myself; his happiness is more important to me. Perhaps it's something like the love that parents feel for their children. I wouldn't know.

I realize that I have shortchanged him these last few months. I have fallen apart; he has held strong--the optimist who encourages me to hope, the one who has taken care of everything, cooked every meal, held me while I cried and shook. And I fell into him, let him carry us both. I forgot to give much thought to how he might feel about failure; how deep his fear and grief might run. When I imagined it, I thought he would say, "Well, we gave it a good try. We'll try again."

When Dr. Katz called, we were sitting in a deserted restaurant. I took the call, very quietly, as he said the words I knew were coming. The "I'm so sorry." I curled my arms in front of me and walked out, unable to breathe, leaving Jeff to clean up behind me once again. To thank the waitress, pay the bill, get the food boxed up. When he got out, I saw his eyes, still dry but so very, very sad. I hadn't even hugged him, squeezed his hand, looked him in the eye when I left. I could only think of myself. But here he was, walking up to me, wanting to hold me and comfort me and feeling my disappointment more keenly than his own.

I want to give that back to him again. I want this nightmare to be over.

Distraction

I have reached the last resort of the desperate-to-be-distracted: I am organizing the closets. It isn't working as well as it should. Heart still in throat; pulse still pounding in stomach.

Should hear today after 2:00 p.m. Pacific.

Monday, April 18, 2005

BFC

No BFP or BFN to report; just a BFC. Big Fucking Chicken.

On the way to beta #1 this morning, I told Jeff that I couldn't take it anymore. The nightmares, the insomnia, the worry, the fear, the panic--I've reached a tightly coiled state of pent-up alarm.

I've spent two nights in that half-waking state of wheel-spinning angst--fretful visions of grotesque cells, lost babies and stark emptiness. In one, the doctor said that my three embryos had turned into cancerous tumors and had to be removed before they grew, though I was to die regardless. In another, Jeff was holding up an enormous pregnancy test, eight inches long and five inches wide, with a series of four lines--all varying shades of HPT magenta--and all I could think of was, How did he get my urine? Did I wet the bed? And I didn't want to tell him that the test was wrong, we're not pregnant, though I knew I should.

My brain spins and whirrs while I sweat and toss and beg for sleep, and every thought leads back to the question at hand: yes or no. Yes or no. Yes or no. Yes or no. It's so simple. There is an answer, and I can have it if I want it. I could call the doctor in an hour and demand the results; I could pee on a stick.

But still I don't. Though it would put an end to my circling agitation, the probability that it would be the end of this particular dream, and that I would come quite badly unglued for awhile, is not something I'm willing to hasten.

Jeff felt the same. He doesn't want to give up the inherent possibility to be found in not knowing. He wants to think on the Minnen Lamm and a Christmas delivery; he wants to ponder names and cribs and tiny clothes, right up till Wednesday afternoon.

So I sit in a dark room with my laptop, pecking away at the keys, stubbornly refusing to hasten my trip to the chopping block, and able to face one fact and one fact only: I am chicken. Hear me bok.

Friday, April 15, 2005

You're good.

Really good.

'Cause if those were lies, they were damned convincing.

I am feeling a little more stable today, less freaked out, though I wouldn't quite call myself happy or optimistic yet. Yesterday was a good day--helped along by aching breasts, which promptly vanished (the aching, not the breasts) overnight, just as usually happens a few days before my period is due to start. But I'm trying. And all of your comments about feeling absolutely nothing, or your friends feeling absolutely nothing, are so encouraging.

At this point, there's nothing I can do but wait and hope. And if I have to wait, I might as well hope.

Speaking of the waiting part: my doctor is a little bit nuts. I am to have my first beta on the 18th--fair enough, eleven days post transfer, about when I expected--but I will not be told the results. After the second beta, on the 20th, I'll get the call.

He says that this is to avoid ambiguity, and also to rule out lab error. The nurse gave an example of one woman whose first beta was negative but whose second was sky-high. Pregnant with twins. He didn't mention the obvious reason for doing this, though, and I didn't say anything. Though it feels paternalistic and even insulting not to be told up-front, I'm willing to suspend my irritation and embrace the fact that this game may give me two more days of hope. Vain hope, perhaps, but hope nonetheless.

Even two extra days of unnecessary PIO shots are probably worth that little glimmer of possibility, the one that clings so stubbornly to the edges of my pessimism, right till the very moment of definitive, disappointing truth.

Wednesday, April 13, 2005

Lie to me

I am in rather desperate need of optimism, hope and a positive attitude right now. While yesterday I was engrossed with the simple thrills of sitting upright, standing and finally taking a gentle walk through the neighborhood, today my focus has shifted to, Am I pregnant?

The resounding answer from my body is, No! Or even, Dream on, you asshole!

I am what I guess I should think of as nine days post ovulation. Six days post transfer. Something like that, anyway. The gonadotropin-induced breast ache is gone. I feel no flutterings or fullness. No indigestion, no nausea, no sensitivity to smells. None of the things I remember pregnancy feeling like. Even the daily cc of PIO isn't mimicking symptoms. Yeah, I know that it's still early, but I've got nothing. Just a melodramatic sense of doom.

I had no uterine twinges and no spotting on the days implantation was supposed to occur. The only odd thing I feel right now is my swollen and manipulated right porcupine of an ovary as it gets smashed against the rest of my innards whenever I move. And that just reminds me more forcefully of the procedure I've been through, and that I am broken.

My doctor insisted that I should do everything in my power to remain optimistic, that it would increase the chances of success. That one's body is better able to hold onto a pregnancy if it is not under a significant mental strain. I don't know how to do that, and I'm asking for your help.

Have you felt nothing, but been pregnant? If not, can you imagine it and pretend, and send me convincing comments about how you couldn't have been more surprised; had no earthly clue?

Just lie to me. Please. I need the hope more than I could have imagined--my mental is straining right now.

Monday, April 11, 2005

Welcome to my futon

I have been spending about two-thirds of my time on the futon in the TV room. Initially, I was using it as a couch, but eventually Jeff decided to put it down to its double-bed size so I could really spread out.

I have watched a lot of television, and I have slept through a lot of television. I have eaten a lot of cheese, and a lot of fruit. I have read things edifying and things entertaining. I have sent (three) and received (many) emails. Sounds pretty good, right? I thought so, too. Till I realized that lying down all day kinda sucks ass.

Know why it sucks? It sucks because I'm worried like I've never been worried before, and I'm cyber-lonesome. I have not been able to keep up with the blogs very well (can't see the monitor clearly from my supine position) nor do any good searching on what embryos are supposed to look like.

So I figured I'd relieve some of the boredom by writing a post, which presented some logistical issues (i.e. not being able to read the monitor) but seemed like a manageable task. Big problem, though: what to write about when you haven't left the house since Friday morning and are not feeling particularly reflective? Not a lot of material, to be honest. So I'm inviting you to relive my bedrest with me. Come, pull up a piece of futon and join me! Exciting, no?! OK, not exciting. I know. I know. And, no, I don't actually expect anyone to read this, so please don't feel obligated. Really. Unless you're having insomnia and are in need of a little soporific.

Here are the movies I watched on TiVo:

Born Yesterday (1950, Judy Holliday and William Holden, v. good)

Coming Home (late 1970s; Jon Voigt makes for one sexy paraplegic, lemme tell you)

Some Kind of Wonderful (who ever thought Leah Thompson, of all people, was pretty enough for a role that required almost nothing but pretty? Mary Stuart Masterson was so obviously the hotter one; why even pretend?)

The Paper Chase (1973. This film highlights very, very bad haircuts. And what ever happened to Timothy Bottoms? Was it his name that did him in?)

Analyze This (thought I remembered this being pretty funny. I was wrong, unless I slept through the funny parts. I've been doing a lot of drifting off)

Master & Commander (Paul Bettany=yumyum; gorgeous cinematography and not too much Russel Crowe, whom I find inexplicably grating)

Father of the Bride II (this was a little, "We thought you might like it!" recording that TiVo did all on its own; I gave it three thumbs down and then deleted the fucker with great vengeance when I discovered that the plot included accidental pregnancy by Diane Keaton at, oh, forty-seven or so)


I also read quite a bit. If you are not yet sleepy with the boredom, please feel free to continue:

Pigs in Heaven, Barbara Kingsolver (entertaining follow-up to The Bean Trees, though perhaps not quite as convincingly written; involves adopted Cherokee girl and no unplanned pregnancies of any consequence)

The Murder Room, P.D. James (haven't finished yet, but it's pretty typical P.D. James stuff. There is a murder. There is a murder room.)

The Eternal Frontier (forget the author's name and can't get up to go check. Fascinating and exceptionally well-written look at the evolution and natural history of North America. Homo sapiens are some seriously destructive critters; those Clovis People most definitely wouldn't be Sierra Club members)


If the boredom and insomnia have driven you to tears and you just need to read something--anything--to put you down for the count, you might as well read all about what I've eaten thus far while on bedrest. Pathetically, I remember every bite.

Two gorgonzola-raclette patty melts with mashed potato casserole, a la Chef Jeff

Salad of field greens with strawberries, almonds and gorgonzola

Salad of field greens with pears, walnuts and gorgonzola

Whole wheat pasta with dried Sun Golds, cashews and gorgonzola

Whole wheat walnut-gorgonzola levain with double-cream gouda

One large grilled eggplant

Four roasted zucchinis

Two pounds of wild rice

Fourteen pounds of sliced Braeburn apples

Six pounds of navel oranges

Seventeen Satsumas

A half-flat of underripe strawberries, minus those used for salads

A cantaloupe

Half a container of Healthy Choice low-fat butter pecan ice cream

Three bowls of kashi with crimson raisins in a bath of Lactaid

One packet of generic graham crackers


Emails checking in on me after the procedure from non-computer friends and family (If you're still reading, you might as well just keep going, because you will be up till dawn regardless. You could read ingredient labels and still not nod off. So I will take my cap off to you. It's a bit greasy from my unwashed hair, but I will doff it anyway):

Five (my friends were very nice but two found the embryo pictures disturbing and one told me that she was "just sure that God would give us our Miracle Baby whenever He's ready!!!")

Other emails from friends and family:

One (My sister, who forgot I had anything going on, even though we talked about it at length last week. She emailed me to swoon about her new boyfriend instead)

Emails from my friends in the computer:

Several (you know who you are, and you made me want to cry. In a good way)


Well, tomorrow--glorious tomorrow!--I get to stand up, walk around and lift objects up to five whole pounds. Can't wait to sit up while typing again! And, even better, I can finally read all of your lovely recent comments in detail.

Friday, April 08, 2005

Twenty-two

Twenty-two. Has a nice ring to it, I think.

There are twenty-two new cells in my uterus. Two eights and a six. The eights received a grade of two, the six a grade of three, on a scale of one to four with one being best; they look pretty rough to me, all speckly and asymmetrical, but what the hell do I know? So not the best, but decent. Better than I feared.

Now I am to lie here for four days and ponder. I can stand up to go to the bathroom or to shower (like I'm going to shower?). Jeff is a benevolent hen, fussing around with my pillows, the couch, my lunch; he rearranged the TV room so the laptop can rest comfortably in the docking station on the side table, the ergonomic keyboard on my lap. He's buying me pie. And gorgonzola. During the transfer and after, he held my hand for an hour, till his shoulder fell asleep. He talked to the embryos. I feel very lucky.


 Posted by Hello

Wednesday, April 06, 2005

Three

Three of the four fertilized. The fourth egg was immature and couldn't be ICSI'd. The embryologist said 75% was typical; for once, we are typical.

I almost fainted when the phone rang with the news--head between knees while Jeff took the call.

I am trying to take your advice and not worry about the insurance situation yet. Yeah, me not worry. Right. It's a little like trying not to proofread--a conditioned response. What I am able to do is to not look quite straight at it, just letting it simmer off on some remote burner where I can watch it from the corner of one eye.

My right ovary was in a difficult position, and they had to move it externally to get its lone egg. Felt instead like they had removed it and replaced it with an orange-sized ball of hurt. A bit better today; I am upright as I type.

We'll know more Friday morning, when the embryos are removed from the vault and examined prior to transfer. If there are still embryos, of course.

Tuesday, April 05, 2005

Four

They were only able to get four. Two arrested between Sunday and today.

Insurance may not cover it. They didn't tell me that I needed three IUI's before they'd cover IVF. Freaking out.

Sunday, April 03, 2005

Ballpark Franks

Despite my pessimism, The Big Six are plumping up nicely on their chemical diet. Barry Bonds would not be unimpressed. The runt of the follicular litter is 17mm, the rest 18 and 19. I trigger tonight at 10:30; retrieval will be Tuesday.

My R.E. was cautiously optimistic about our chances, and talked with us at length about what's going on with his practice. He will be in business through the 27th, at least, and then an old colleague of his will be taking over if the board's decision is not overturned.

I decided yesterday that I am done with the wallowing, with feeling like an emotional invalid. So I decided to face some fears: first up, I did my own damned shots. And, with enough ice, they weren't as bad as I expected, just a little creepy. Then, despite my previous, and most emphatic, refusal, I told Jeff I would, indeed, accompany him to the wedding. We went, there were pregnant women everywhere, a good friend let slip that she's expecting again, the bride was annoyingly gorgeous in her sixth month, there were two dozen beautiful babies and toddlers, and I managed to enjoy myself anyway. It was oddly liberating. And I ate a pound of raw-milk Cowgirl Creamery cheese, just because I could.

I am not going to apologize today for apologizing yesterday for being a wuss on Friday, because I might find myself apologizing for apologizing for the apology tomorrow, and that could get downright silly. So I'll just say another "thank you" for your kindness and support, instead, and know I mean it truly.

Saturday, April 02, 2005

Over- All

You are like a calm tide in my roiling sea. Thank you for keeping me afloat. I never knew how much I would come to rely upon the kindness of strangers, of strangers who feel like friends.

I was not myself yesterday. Or I was a part of myself that I don't want to believe in.

I was overemotional. I was hopeless. I was so full of self-pity, and helplessness, and shame. Shame for my lack of fortitude, shame for my body's failure, shame for being so wrapped up in this that I could not think of anyone else, even Jeff.

I went in overconfident, believing I would be a follicular overachiever, with my shiny E2 numbers. I did not know that I was an under-responder. I did not know that my doctor, who has been kind and responsive and gentle, had just had his life ruined.*

I came out overwhelmed, overwrought, overly dramatic. I overreacted.

I am sorry. So many of you have borne up under worse news, and I must seem like a dilettante by comparison.

Over all, the news could be worse. I have six eggs. Better than none. I assumed that this poor response meant that the eggs would be bad. Eventually, I stopped shaking and crying, and I started Googling. And it seems that they may be OK. Who knows.

Nothing is lost yet, except what was left of my confidence. Perhaps I don't need it. But you? You, I need.

*He was previously cleared of any wrongdoing in the matter--twice--but the case got a lot of press recently, and, predictably, became politicized, and now his patients will lose, as well as him and his wife and two young children. Some patients and former patients are planning a march in his support; he is much loved, and will be missed.

Friday, April 01, 2005

Reality

My R.E. wanted to see at least 10-12 follicles today. He expected to see even more.

But there are six. Just six.

He said, "Well, I guess now we know what the problem is."

I couldn't think. I couldn't form a question. I don't know what that means.

Today, my R.E. also lost his medical license. He made a grave error five years ago, perhaps he deserves it. I am too buried in grief to care.

I'm considering giving up. Today.

I can't stop shaking.