Monday, September 25, 2006

Last Dance at the Center

IUI #3 was a bust too. AF arrived right on schedule. So we’re now on CD #8 of IUI #4, or what will be my last medically-assisted attempt at achieving a pregnancy. My left ovary, for some reason, has, for the past two cycles as well as this one, become the overachiever in the pair, producing follicles like there’s no tomorrow (but, luckily, within the range of acceptability, so there’s no talk of hyperstim’ing or canceling of a cycle). I have just gotten the call that I trigger tonight, and the procedure is scheduled for 11:00 a.m. Wednesday.

I am trying to stay positive. I am trying so hard to grasp the edges of my reality. I may never be pregnant again. I may be ending my childbearing years not out of choice. It’s funny, because when we started this journey, I had drawn my lines in the sand of what was and wasn’t acceptable in terms of medical assistance. Now, as the time grows shorter and my chances fewer, I’m willing to grasp at straws that before weren’t feasible. The rational side of myself keeps yelling out, “Give yourself a break. Be done with this part of your life, accept the results, and move on”. The emotional side of me says, “Bullshit! We’re not going down without a fight!” The question to answer is how much of a fight am I willing to give Mother Nature.

The other person in this intricately timed dance has made his feelings very clear. DH has had it.
Thalia recently blogged about how often we forget how sad our men get. I have known from the start of this entire process that he was just along for the ride because his alternative was divorce. I mean that. No anger, no hostility. Just a very factual statement. When we lost Jimmy, we were still in the throes of dealing with the after-effects of DH’s heart attack (at age 38). It was like we were living in a snow globe that some idiot picked up and shook, and I was trying desperately to get us back to some sort of normalcy, some level ground. I wanted to make sure, most of all, that our two boys were not traumatized unduly by this twist in their lives. You know, I just didn’t want to them on the six o’clock news, shotguns in hand, screaming that it was all because their father had had a heart attack when they were 8 and 4. So we dealt with it.

For the record, I come from a family of people who have had the Fates deal them really shitty hands (DF’s parents died within four months of one another when he was 11; DM’s DF (my DGF) was a nasty drunk who beat up my grandmother and couldn’t keep his zipper up around town (much before my time; he was a great GF to me). I have suffered my own trials (molested by a friend of my parents’ when I was 4, and again by a teenaged male babysitter when I was 8). I’m a survivor. And I’m not particularly fond of those who use the circumstances of their lives as an excuse for their poor behavior. Sorry, but everyone has a drunken/
molesting/divorcing/abusive family member somewhere in the branches of the family tree. Get over it and get on with it.

So, when the Fates saw that I had managed to keep my family on course, upright, and afloat, they decided that I must experience losing a perfectly healthy child seven months into my pregnancy. I must bury him. I must live with that loss every day. Then, just to piss me off, they decided that the next pregnancy would begin badly and end quickly. Oh, and for good measure, they would have the biggest BOOB of a doctor NOT do a D&C, but instead let the whole episode drag on for TWO fucking months before my OB/GYN (same practice, different doctor) finally got a clue as to what was going on and did a hysteroscopy/D&C.

Then, as you can read on this blog, I’ve had issues with my lining and the insurance folks at the Center. And through it all, I have struggled on. Trust me, there are mornings when I sob as I drive down the highway towards my impending date with a needle and an ultrasound wand, wishing for myself and all of us that it were not this way. But it is.

I think a lot of my demands regarding our stroll down Infertility Lane came from the reaction of my family members, particularly DH and DM, when I got pregnant with Jimmy. The questions about how I would juggle three boys, a DH who doesn’t do much to help out, and working full-time. The negative vibes over the pregnancy. Then losing him, and trying again. More negative vibes. The impressions that no one could understand why I couldn’t just stop pursuing this, another pregnancy. And me “getting my Irish up” as they say, and deciding that I would decide when it was enough for me. I told DH that this was the only thing that I had ever asked of him. I had stood by him when I found out he was in debt (oh, yeah, and bailed his ass out), when he was audited by the IRS (because he has no clue what “record-keeping” means), when his parents and brothers came before me, when he changed jobs a NUMBER of times, when he needed a push to finish his degree, and so on and so on. I have always been the steady one, the grounded one. So when he said “I’m done. We have two healthy kids. We lost Jimmy. We lost another one. I can’t do this anymore,” and then put back on thirty pounds post-heart attack, I drew my first line. Told him nicely that he could hit the road in that case, so that I could pursue a relationship, and a pregnancy, with someone else. That sounds so heartless, but, for me to be able to not hate myself for quitting, I needed to forge ahead. And, in my mind, if my best friend and partner could not understand that, and (more to the point) couldn't do that for me, then he truly was not the person I thought he was, and not the person I needed to be with. You don't want to think that, when push comes to shove, the person you've chosen to be with turns out to not really know you at all.

I truly, deeply love my DH. He is my best friend. There are no words to express the terror that I swallowed in that ER three years ago on October 20 as the doctor walked me into a private waiting room (NOT a good sign, for the record) and told me that DH had had a heart attack, and, if the clotbusting meds didn't work within the hour, they were MedFlighting him to Boston. I didn't know that terror could be surpassed hearing another doctor say, three months later, "I'm so sorry. I don't see a heartbeat.". Quite honestly, though (and I'm not saying this in a bragging, toot-my-own-horn manner), the one who held it together was me. And those moments when I couldn't, it was my mom and dad. Because they (the medical staff and my parents) were afraid of what the stress of the induction and delivery of Jimmy would do to DH (he was gray around the gills, and I found out later they had a crash cart waiting outside my L&D room for him, with a cardiologist on call), my mom stayed with me through the whole thing. My dad stayed with DH. Through all of this, I have learned that you don't get a choice in getting off the ride halfway through; you have to stay on until the end, like it or not. And I have learned that I need to put me first sometimes, particularly regarding this issue, because no one else will.


The man who loves me deeply resolved himself to this path I have forced him down. I don't know if he has any grasp of my need to do this, to be able to say “I did everything I could, short of IVF, to be pregnant again”. But he is here with me, willing to do this because his alternative was living without me, without our marriage. We don't talk about it. I mean, at all. I just let him know when his appointment is, and he shows up. He cannot find the words, but I know his thoughts are not joyful and happy ones when his monthly presence is required. The first month (June), I tried to talk to him, which quickly dissolved into me screaming and crying while he stood there looking at me with a half-smirk, half-"oh, give me a break, I went and gave them a sample, didn't I" look. I ranted, finally identifying what was making me so emotional (besides the hormones): I was the only woman in the Center waiting room without a male companion. Everyone else was having their hand held by their guy while they gave blood, had the wand stuck up their hoohaa, and were possibly impregnated with their child. Me? I drove myself in, sat by myself, waited through the procedure by myself, and drove myself home. I pointed out, rather harshly, that it would be nice if he could at least be in the room if that were the moment our child was being conceived. The next day, he waited with me, with the look of a kid who'd been shamed in public on his face. But he was there. Since then, he's been there for most of them. I don't mind if he just goes to the Center, leaves his sample, and has to go right back to work. That I understand. But it is nice when he at least waits in the parking lot for me, and gives me a squeeze and a kiss.

So, here we are, on the last round of IUI. I turn 40 in three months. I had said I’d clean out the baby stuff, the clothes, the crib, the strollers, in October of this year. I will put it in the attic for now, and get to the other side of the holidays and my birthday. I need to get to that side before I can face the sadness that I will have to deal with when I clean it all out and send the signal that I am truly done with my childbearing years.

Wish me luck. I'm gonna need it. And, for the record, my left ovary is KILLING me right now!

Monday, September 18, 2006

Insurance Hassles (AGAIN!)

Well, it’s been almost a month since I last wrote to my blog. Needless to say, by now I know my body way too friggin’ well, and AF promptly arrived in her full glory that Sunday morning, kindly enough so I could let the ladies in the monitoring room know that the bloodwork that I had driven down through the pouring rain for was no longer necessary.

As a side note: decided to give acupunture a shot, which I did the day after my last blog. I had an appointment with a group affiliated with my Fertility Center, and I was spurred on by the literature they provided in the waiting room, particularly with regards to the rates of improvement for IUI patients. Had a great session (it did relieve the PMS cramping), had no problem with the needles (who would after sticking themselves as much as IF patients?), and then decided that I wouldn’t pursue any further treatments. Why?, you ask. Because the gentleman that saw me told me that they like to “get their patients ready” by doing a combo of acupuncture, herbs, and other stuff while having the patient take a three-month breather from IF treatments. Thanks, but my clock is ticking and the DH is becoming inpatient with this whole thing, so we’ll have to forge on without Eastern medical assistance.

So, IUI #2 is a bust. They call me later that day to tell me, yes, once again the Insurance Monster has put a note on my file, and I can’t come in the next day for IUI #3’s CD2 u/s and bloodwork. Now I’m pissed. Last month, we went through the same crap. So I leave a voicemail at the center in the general mailbox, telling them I want this solved by noon on Monday and a phone call telling me I’m good to go. Surprise, surprise… no call. 1:30 p.m., I start calling. Because the girl in Insurance that I was referred to is on vacation, I’m going to have to deal with L, which by now stands for “LOSER” in my book. She’s at lunch. Then I get the office manager, S, on the phone. As she tries to put me off, I tell her that last month L dropped the ball, and I shouldn’t be doing her job. Then I call Tufts.

Now we have the “chicken versus egg” dilemma. New regs at Tufts demand FSH levels on CD3 and CD10. Tufts won’t approve the IUI cycle until they have those. The Center won’t let you do a cycle unless you have prior approval or you shell out $2600 upfront (NOT an option in my household right now). The head of the ART office at Tufts is on the phone, somewhat patronizingly telling me where the prior approval form is located on their website, and that, if the Center sends it through as a priority, they may be able to okay it. Much pissing and bitching on my part, and she snaps to attention when I mention that I have not received notice of these changes in my coverage as promised last month, and will be contacting the head of Tufts about their lack of customer service.

Ladies, this is when the Internet proves to be a great, wonderful place full of interesting information. As I look at Tufts’ website, I find the document that I still haven’t received in the mail. On page 21 is the name of the M.D. who is the VP of Medical Affairs, and apparently the jackass that didn’t see that his new regs might be causing some issues. I call Tufts membership line, and some very sweet young rep gives me this guy’s DIRECT LINE! And he answers it himself!!! After totally confusing and scaring this poor man with my tale of woe and talk of being on the 6:00 news, he tells me he will look into this situation and get back to me. Fifteen minutes later, one of his people calls me back, a lovely woman who sympathizes with me and asks for everyone’s names who I’ve spoken with both at Tufts and the Center. She then calls me back twenty minutes later, telling me we’re all set, and “oh, by the way, I know you said you were only doing one more IUI cycle, but I’ve given you approval for two so that if you change your mind, you won’t need to go through this issue with us again”. Hallelujah! We’re on again!

Turns out, after all that, that Tufts had contacted the Center and told them that they would be willing to work out any issues that came up with the new regs (and, yes, I believe Tufts). The best part: the test results that Tufts needed I had had done at the Center in October, and those satisfied their requirements.

The Center calls, and I’m in the next morning for u/s and bloodwork. Then S calls, and patronizingly says “are you doing better today?” Smarmy bitch. So I unload. She states that she’s going into a meeting with L and will bring all my issues up. I tell her great, and I’ll be sure to bring up both L and her attitudes when I speak with my RE, who happens to own the place, as well as speaking with the other partners. I tell her that, while everyone in the medical part of the Center is pulling for every patient, she and L appear oblivious to what a three- or four-day wait can do to an IF treatment cycle, and seem to do their best to be unsupportive and difficult. And oh, I’m sure to let the partners will be interested to hear that I have had to take care of my own insurance clearances for two IUIs in a row. The minute I mention this, she becomes somewhat apologetic. I could care less. I also mention that the VP’s person who gave me the two months worth of approvals told me that she personally spoke with someone at the Center the week before regarding the issues that Tufts patients would be facing, and how Tufts was more than willing to work on these issues with the Center. I thank her again, telling her that I appreciate her addressing these issues with L, and that I’ll be sure to mention that when I speak with my RE.

Now for the real challenge. DH’s agreement with me was that he would do three IUIs. That was IUI #2, so obviously IUI #3 will be in the beginning of September. Now we have permission to do 4 IUIs, and somehow, in the back of my mind, I’m considering the extra cycle a gift. To do any more IUIs would be a total hassle with the Center getting insurance clearance, and honestly, I don’t know if I can emotionally take any more of this. Something for me to think about…