Nursing School Vs T.M.I.

Those of you out there with a background in healthcare will probably be familiar with the following conversation:

“Hello unassuming stranger, looks like you’re getting ready for the storm with all your milk and bread!” said the elderly lady in front of me in the supermarket line. (I should explain that when there is a big snow storm in New England, milk and bread suddenly seem to become very hot commodities. Seriously…two weeks ago there was a news story about the shortage of milk and bread in grocery stores here in the Boston metro… so, naturally I panicked, immediately went to the store and bought as much as possible in an effort to fit in. This is the second year I’ve done this.)

“Yes, I have both milk and bread, because I’m a New Englander and that’s what we do!” Said the boy from California desperate for approval.

“That’s great! I hope it all fits in yah cahhh. (that’s “your car” for people not from Boston) So, what do you do young man?” she asked while loading her milk and creamer on to the belt.

“Actually, I’m just finishing nursing school.” I said as I silently cursed myself for forgetting milk related products like creamer. I did however feel slightly vindicated noticing that she didn’t have naan bread like I did. Surely I should get extra points for variety of bread products.

And then it happened…

“Oh…” she said with a sudden gleam in her eyes. “So, maybe you’ll know. I’ve got this boil right in between my…well my you know what. Do you think I should pop it, or just leave it be?!”

A slight gasp escaped my lips as my hand rose to my forehead awkwardly.

“.......Oh. Well…ummmmm……..uhhhhhh…..huh. Oh look, I think the cashier is ready to take your coupons!” I responded knowing full well that no amount of milk, bread, or acceptance was worth enduring that conversation.

This is one way that nursing school leads to too much information. (At least I learned something about myself: Evendently, I have to be in the right location to talk boils with a little old lady. In the hospital, no problem. At Stop and Shop, not so much...)

There is also another way that nursing school provides too much information. I spent last summer in my OB/peds rotation, which was amazing. We were able to assist with deliveries, give babies the all-important first vaccines,  care for newborns in the neonatal care center and NICU, and teach new moms and dads how to feed, hold, change, and  care for their new little ones. Yes, it was as awesome as it sounds.

But there is a drawback. While we as nurses are expected to know the natural progression of fertilization, pregnancy and delivery, we’re also expected to know the complications that can come along with fertilization, pregnancy and delivery. (Even more so than a complication free pregnancy.) After all, being prepared when something goes wrong is one of the most important roles of a nurse. We’re kind of like boy scouts in that way. 

Those of you who are going through a similar journey to ours know how difficult it is being removed from so much of this process. Add to that in depth knowledge of everything that can go wrong at any given time in development, and you have now discovered why during the last attempt I turned into a basket case for bursts of 5 minutes every other day or so. To know about everything going on, and to know that you’re physically so far removed from it all isn’t easy. But it’s what we sign up for as IPs going through international surrogacy.

That said, as we gear up for our next shot I take a moment every now and again and remind myself: what will be, will be. I am determined to try to enjoy the process as much as possible, regardless of how difficult that is. So now, I tuck away my paranoia; my doubts; my worries; my fears, and I try to think about this little dream of ours that we're working so hard to achieve. I am determined to once again find the delicate balance between being vigilant and involved, and just being flat out crazy.

We transferred funds to New Life last week. $10,700 for a second attempt with the same egg donor as last time cycling for us and fresh embryo transfer.  No word yet on when our fabulous ED will start her cycle, but hopefully we should be hearing about it sooner rather than later. (In fact, my next email is going to be to our NL contact to confirm they have received the funds and find out about getting a timeline.)

Hopefully things will get rolling soon. And hopefully this damn snow will clear up so I can go back to my low carb lifestyle.

Joy Vs Pain

The American philosopher and author Joseph Campbell once said: 

“Find a place inside where there’s joy, and the joy will burn out the pain.”

Frankie and I are currently seeking out the joy in our lives.

This past weekend we got an email from New Life letting us know that although the fetal sac was visible, there was no visible fetus, and thus no detectible heartbeat. They have taken the surrogate off of medication, and expect that the lining and sac will be discharged.  (I have many thoughts on this that will come in a later post. Our poor surrogate… L )

It was a tough email to receive, but as you may guess after my last post, in a way it was a relief. At least now we know.

Naturally, we’re very saddened by this news. But it’s not end game for us. Not by a long shot. While I totally understand why some celebrate the beta tests and the early pregnancy indicators, we never fully celebrated those moments. We found great joy in them, but we didn’t celebrate. Each IP has to view this process through their own lens, and we knew that through our medical lenses, the pregnancy wasn’t viable to us until we had a heartbeat. While I know that some people don’t agree or understand why we didn’t enjoy the emotions more, we restrained our emotions for this very reason. Our hearts were protected…to some extent at least. There were still some tears….and some cherry pie from Thanksgiving that disappeared a little too quickly…but overall we’re doing ok. It’s a process that won’t happen overnight, but we know we’ll be alright, and we’ll come through stronger.

Fortunately, there is no lack of joy in our lives, so the residual pain doesn’t stand a chance. Before we got married, we talked a lot about our future together. We both knew that we wanted children, but we also both knew that we wanted to be in a relationship that didn’t need children to be complete. We’re already complete and although we both want kids more than anything in this world, we don’t need anything more to fill our lives together. Any children we have would just be the icing on an already wonderful cake. The joy we bring each other is enough to burn out any pain we’re faced with in our lives, and it gives us the confidence to know that any children we are fortunate enough to have will only add to the love we have in our house; not be born to fill a gap in our lives. And that feels wonderful. It means we can be patient. It means we can be happy that we got so far the first time. And it means we have the strength to try again.  

Joseph Campbell also once said: 

“Follow your bliss, and the universe will open doors where there were only walls.”

That said, we’re ready to knock down some walls…. 

Presumptive Vs Probable Vs Positive

In the world of Obstetrics, there are three stages of pregnancy confirmation: presumptive, probable, and positive. Believe it or not, a "pregnancy test" as we know it is not a positive (or conclusive) test; it only gives you a probable result. Here are some examples of the signs of pregnancy confirmation, and what other factors might be causing them:

Presumptive signs of pregnancy

·         Missed period  - Sorry, but if you’re 60 and you missed your period….probably not pregnant

·         Nausea / vomiting - Really? You thought eating sushi from the gas station was a good idea?

·         Weight gain – Are you American? Enough said. (But sadly…we’ve finally been dethroned of having the honor of fattest country in the world! Thanks a lot Mexico…)

·         Fatigue – Bad news, you’re not pregnant….more bad news, you have Lupus…

·         Breast Tenderness – You got a little out of control after reading 50 shades of grey…baby steps.

·         Quickening (A “flutter” of movement…when mom says, “I think I just felt the baby move!”) – Please refer back to gas station sushi. This can be gas or peristalsis.

Probable signs of pregnancy

• Hegar's sign (softening of lower uterus), Goodell’s sign (softening of cervical tip), or Chadwick’s sign (vaginal mucosa turns violet-blueish) – I hope you aren’t basing your results after any of these, because they require palpation and some spelunking! So probably not things you would want to do at home. However, if you are, all of these things can be caused by pelvic congestion. 
• Ballottment (By far my favorite!! This is when the examiner places a finger within the vagina, taps gently upward against the cervix, and leaves their finger there. This causes the free floating fetus to rise, only for gravity to make it sink back down, and the examiner feels a light tap on her/his finger….how cool is that?! It's not really used any more, but still very cool.) – Not sure what else could cause this. My nursing textbook claims it could be cervical polyps…but I’m thinking maybe a marble got up there somehow? 
• Braxton-hicks contractions – Sadly, these can be caused by a tumor. 
• Urine pregnancy test – The at home classic! The problem is, a pregnancy isn’t the only thing that can cause a positive. Pelvic infections, tumors, and simple user error can lead to false positives.
• Serum pregnancy test – This is the one we in the surrogacy world all depend on! We get our Beta HcG levels, we compare how they change, and if they rise appropriately, surely we know we have a baby on the way, right? Nope. A molar pregnancy (caused by a hydatidiform mole, or a large mass, growing in the uterus) can also be the culprit. Also, a non-viable pregnancy can also cause these levels to rise. 

And this is where we are currently in our journey. We’ve gotten the coveted positive on the serum pregnancy test…and we’re over the moon thrilled. Our beta levels showed significant rise going from 120 on the first test, to 1793 on the second test that was taken just less than a week after the first. This means that the levels are doubling in less than 48 hours, and that seems to be highly desirable. The likelihood of anything but a viable pregnancy causing the beta levels to rise like that is really very low, and that feels amazing.

 But, we’re not letting our guard down just yet. It’s not until we get to the third stage of pregnancy confirmation that we’ll be able to relax knowing without a doubt that we have a viable pregnancy. And that third stage comes within the next week. For us, it will be an ultrasound to detect the heartbeat. Nothing else in this beautiful world can mimic that little flutter of a heartbeat within the womb, and so it is accepted as a Positive sign of pregnancy. Here are the other methods of solidly confirming a pregnancy:

Positive signs of pregnancy  (The only ways to be 100% certain that you have a pregnancy and nothing else could possibly be causing a positive.)

• Ultrasound to visualize fetus in real time or detect fetal heart tones.
• Doppler to detect fetal heartbeat.
• Fetal movements palpated by nurse, nurse midwife, midwife, PA, or physician (Interestingly, movements felt by the mother don’t count. It sounds crazy, but one of the last case studies we had involved a woman with a psychosomatic pregnancy, or a pregnancy manifested only in her mind, right down to distended belly and her claims of feeling fetal movement. Very interesting stuff.)
• Fetal movements visible through the abdomen (Not even the dreaded gas station sushi could do that!)

By this time next week, we should hopefully have a positive confirmation of our pregnancy. It’s amazing how much your life can change in one short week.

Here’s hoping for the best. 

Emotional Restraint vs. Hope

Every nurse faces the same challenge at some point in their career. I faced it last semester during a clinical rotation for my nursing program. I was part of a cardiac code team; pounding on a woman’s chest as the rest of the team provided her with oxygen and various meds in an effort to resuscitate her. But we failed, and just like that she was gone.

When the physician told me to stop compressions, I stepped back, took a few deep breaths as he called the time of death…and I felt numb. This was part of my training. As nurses we are taught to care for our patients like we would want our loved ones to be treated. We are also taught to distance ourselves emotionally. For a good ten or fifteen minutes, I achieved that goal. I had given all I had to give, while still trying to protect my own emotions. It was while we were preparing her body for the family to view that it hit me. I saw one of the techs remove her wedding ring to give to her husband, and with that, the numbness cleared. I promptly excused myself, went to the bathroom, locked myself in a stall and cried until the burning in my eyes forced me to stop.

It remains a mystery to me how we are supposed to care for someone in such a deep way and then not feel broken inside when our best attempts to save them fail. The good news? I cried a little less the next time this happened.

I have tried to approach this surrogacy journey with the same caution. I try to hope for the best…but only in an emotionally restrained way. I can nurture the idea of having a child, but I have to stay emotionally distanced to protect myself. But every once in a while I can feel myself slipping, and today I allowed myself to do something dangerous.

We got a report from our agency telling us that our Egg Donor had a preliminary scan that showed 20 follicles developing. I became really excited. This was the first news that we’ve gotten that makes me feel like it’s all actually coming together and that’s when it happened: I let myself really hope that this will all work out. I threw away my restraint, and let myself really hope.

The problem with that is, the further you get your hopes up, the further they have to fall.

I know when it comes to IVF and surrogacy, there are no guarantees. But despite my best efforts, I’ve already managed to: mentally design a nursery, wander down the baby aisle at Target, start thinking about names I like, start eliminating names I don’t like, and start making up new and inventive names like “Ragdoll Curtain-rod” …you know, in case I take off as a celebrity. This is all very well… but it’s also a game of emotional roulette. What if this doesn’t work out, and all I’m left with is the image of a nursery that my little Justin Case will never exist to use? (Hey, if Kim and Kanye can have a kid named North West, I can have a kid named Justin Case…but really, celebrities need to stop with the cruel names.)

Financially, this process isn’t cheap. We’re extremely fortunate to be able to try this even once, as we fully realize there are others who don’t have that luxury. However, we can only afford a certain number of tries until we would be forced to take a hiatus in order to reestablish our funds. I think some people assume that because Frankie is a physician, we’re rolling in money; when in reality we’ve only done that once and it was after a very odd night in Vegas that we choose not to speak of… (Because you know what they say, “What happens in Vegas, makes you feel like you need a shower and antibiotics”… What’s that? That isn’t Vegas’s motto? Huh.)  In all seriousness, we’re not struggling, but we’re not thriving just yet either. Medical school isn’t cheap, and we have a combined student loan debt that exceeds the cost of the average home here in the US and last month Frankie’s loans came out of deferment, so it's time to pay the piper.  If we ever want to have a mortgage or perhaps a college fund for any children we might be fortunate enough to have, we need to work on paying down our own debts. To sum it up, when it comes to more attempts from scratch: Our spirits are willing, but our pocket books are weak. 

So, I try desperately to keep myself in a state of restraint, but hope is a powerful emotion. I’ve allowed myself to get too close to patients, and that’s left me in tears. I can’t allow myself to become too close to the idea of a child that might never come in to existence because I’m afraid of what that might do to me inside.

 But what I can do is cautiously wish for one of those 20 follicles to develop, be fertilized and become something that will make our lives complete. I can cautiously wish, and leave the rest to fate.