Alternate Routes

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When I started looking at nursing schools, I made a plan that looked something like this: get my associate’s degree in nursing (ASN) at the community college where tuition was affordable, practice for a few years, then go back for my master’s in nursing (MSN) after we’d had a couple of kids.  I knew that bachelor’s in nursing (BSN) was becoming more and more necessary for hospital, management, or critical care jobs, but I already had a bachelor’s degree in English and didn’t see much value in getting a second one.  I looked into MSN programs that would allow me to skip that step, found them reasonable, got my ASN, and started on having those couple of kids.

Ha.

In any case, after IVF bills, NICU, and knowing that we still have FET bills and a bit more time in TTC world, I am nowhere near ready financially or ability-wise to commit the time/effort to go after a master’s degree.  I’m not even quite certain what direction I’d want to go in for that master’s degree any more.  None of this mattered so much for a bit.  I was completely embroiled in doctor and therapy appointments, trying to get E to eat, and dealing with life as well as learning a new department at work.  I had a job, that was what mattered.

Into all of this entered a co-worker a couple of months ago who mentioned that one of the other local health systems was now pushing for all of their RNs to have BSNs.  While it didn’t threaten my position, I did sit up and take notice.  It marked the first time needing a BSN (or higher) had come up this close to home.  I saw the writing on the wall: it was time to talk about next steps.

At first, I re-researched the MSN programs.  Maybe I could fit it in somehow.  The research, however, more or less confirmed that an MSN was simply not in the cards right now, or really, for at least the next five years.  I took a deep breath, looked into BSN programs, and found an online one through my state system.  The price was reasonable.  Most of my credits transferred.  The coursework looked manageable with all of my other responsibilities.

I applied, got accepted, and plan to start in July.

It means I can wait until I know what I want to do for that master’s degree.  It means I don’t need to worry so much about jobs.  It means I can wait ten years or never go back to school if that’s what I want.

It’s not the route I envisioned originally.  As far as alternates go though, I’m pretty excited about this one.

This post is part of Microblog Mondays.  If you want to read more or get in on the fun, please head over to Stirrup Queens.  Thanks to Mel for originating and hosting!

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Odds and Ends

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Watching the penultimate episode of Downton Abbey, Edith, speaking to her sister Mary, tells Mary that in the end, they will be the only two left who share the memories of their parents, their late sister Sybil, and of growing up together. It put into words a feeling I’ve been trying to articulate since my brother died, a very particular facet of that loss. In the end, I will most likely be the sole keeper of those family memories.

~*~

Listening to Arthur congratulate his brother this week on the birth of wonderful twin niece and nephew, it’s decidedly bittersweet. I’m so excited to be an aunt to these babies. We are glad for a safe birth at 32 weeks and babies in good health for their prematurity. I’m so happy E has cousins, and I know both Arthur and his brother hope to keep our families close. I am grateful for E yet again and the extraordinary circumstances that meant we were able to take her home. We are glad that E will know this uncle and aunt and their little ones.

My brother was surprisingly good with small children, although he would have been the first to deny that. He always took them seriously, listened to what they had to say, and as that’s often a rare quality in adults, they would follow him around chattering, excited to have found someone that heard them. I wonder what E would have told him, this uncle she will never know except in photographs and stories.

~*~

It’s one of the things that’s a bit hard about this birth, it comes as my period starts after the first sort-of two-week-wait I’ve had in a while.  We said we weren’t going to do this, but when my cycles suddenly regulated out on their own, we couldn’t resist. No intervention or fertility treatment, no idea if I actually ovulate, no idea if my left tube is open, just a very long shot on a natural cycle figuring it has been a year since my c-section, I’m not getting any younger, and we’re not doing any more fresh IVF.

Even though I know better, even with plans for a much better shot with an FET in the fall, I found myself half-hoping and with that small disappointment, I find myself counting the losses again: my own sibling, whether or not E will have a sibling, the long five day wait with nothing to do except sit by E’s incubator, watching the monitors alarm, wondering if E’s brain ultrasound would show bleeding before we could even consider holding her, the scariness mingled with her first kangaroo sessions as her oxygen saturation dropped and it took two nurses to get her into position, the twins I lost after the first IVF, the ectopic after my FET. I wonder about those lost babies, if they would have looked like E or her cousins?

I wonder if E will be left as the lone memory keeper for our family.

And I hate that this is what suicide and infertility and extreme prematurity have cost me, at least for now: unadulterated joy and happiness without complexity.

This post is a part of Microblog Mondays.  If you want to read more or participate, please head over to Stirrup Queens to check it out. 

A Wonderfully Geeky Valentine’s Day

I like both posts I messed around with today.  So I’m keeping them both, and double posting 🙂 – sorry for any confusion. 

Arthur and I have been trying to learn our new city. From the best routes to go from point A to point B to where to get groceries to finding a favorite latte, we’ve gradually begun to find the places that make it home.

On the list was a sweet shop several people had recommended to us but we hadn’t had a chance to try. For a Valentine’s Day treat, we decided to go and check it out.

The specialty of the shop? “Geek” sweets. They make all kinds of superhero, Star Wars, and Harry Potter confections, including chocolate frogs (that alas, don’t seem to jump), a truffle Darth Vader, and “zombie brains” (a green-tinted white chocolate shell with cherry cobbler filling). They also have a rotating menu of deserts they prepare in house and that can be enjoyed with drinks such as butterbeer or pumpkin juice.

This, of course, was right up our alley. I am a huge Harry Potter fan, and am fluent in Star Wars. We came home with the aforementioned zombie brains, a TARDIS, and two versions of the Millenium Falcon (smuggling peanuts with maple cream in one, nutella and bacon in the other). Quite a fun Valentine’s Day outing, and we look forward to one of these days going for one of their in-house deserts.

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No Lord of the Rings sweets, though. Perhaps one of these days they’ll make lembas. Hey, a geek can dream!

Not Just Another Page In History

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As I was sorting through my bookshelves recently, I was working on winnowing my “Tudors and other assorted European royalty” shelf. Mostly comprised of Tudor history, I have books on Elizabeth I, Jane Grey, and of course, Henry VIII and his six wives among others by authors such as British historian Alison Weir, Antonia Fraser, and Eric Ives. One book made me pause as I picked it up.

Titled The Lady in the Tower: The Fall of Anne Boleyn, author Alison Weir recounts the trial and execution of Henry VIII’s second queen. It’s a very interesting read if you’re in to Tudor history. Weir examines the great lengths Henry VIII went to, trying to put an official, righteous gloss on the entire sordid affair to appear justified in ridding himself of this wife and marriage. It didn’t work, needless to say. History does not look kindly on Henry VIII’s execution of Anne. Anne’s story is especially poignant and ironic given that her daughter Elizabeth became one of the greatest queens in British history, truly the legacy Henry VIII went to such terrible lengths to ensure.

I was reading it a little over a year ago during my second fresh IVF cycle and stopped in the midst of a passage talking about the fear and anxiety Anne endured as she waited for her fate. I had a visceral moment of identification with this woman who had miscarried and in the end, most likely died because of her inability to produce the desired child. I don’t think I’ll ever be able to look at Anne’s story and eventual execution quite in the same way again, from a comfortable distance of centuries and a complicated legacy (some of the best contemporary sources on Anne Boleyn are the letters of the ambassador to Charles V, a man deeply partial to Katherine of Aragon and extremely hostile to Anne, which makes it difficult to suss out the true dimensions of Anne’s personality).

It was a sobering reminder of the very real ways infertility and pregnancy loss have affected families and people’s lives throughout history.  I put the book back on the shelf, but I don’t know that I’m going to read it again.

This post is part of Microblog Mondays.  If you want to read more posts or join in, please go visit Stirrup Queens.  Thanks to Mel for originating and hosting!

Have been messing around with this post, but I think I’m sticking with the original – sorry for any confusion.

 

Deciding or Escaping

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Last night, we were watching the Superbowl, me in a pleasantly hazy exhaustion up far past my usual Sunday bedtime watching ads, Arthur texting with his brother and actually watching the game. Arthur has a pretty big soft spot for Peyton Manning and thus was rooting for a Broncos win.

I’m not an NFL fan for numerous reasons (college is a whole different story, although I wonder these days about the ethics of watching a sport I’d never be excited about anyone I was close to playing due to the high injury risks), but I do love narrative arcs and I’m a sucker for a good story. As much as I grumbled every time Manning was made the big news (because as far as I can tell, the Broncos defense mostly won the game), I wondered if he’d go for the sports-fairy-tale ending, announce his retirement and sail off into the sunset.

At the end of the game, with reporters pressing him over and over and many allusions to his likely pending retirement, Manning said something that didn’t give the neat ending but that surprised me a bit. Manning responded that this was an emotional night after an emotional week and said “I got some good advice from Tony Dungy, and that’s not to make an emotional decision…I’m going to go kiss my wife, kiss my kids, and celebrate with my teammates.”

Around the third week E was in NICU, I got a cold, couldn’t see her for a week, then had the NEC scare and the rollercoaster started on a downward dip after the high from E surviving birth. This kicked off what I can best describe as a mindset of resolutely looking forward as we raced along through the lows and highs of the last year, which were some of the most pronounced I’ve ever experienced. We’d barely moved into our new place, had a baby in NICU, new job for Arthur, new position for me, my brother died, and yet, here I was, worrying about whether or not we should make plans over the next year or two to move to a different city, which would have also entailed (another) job change. I wondered if I was on the right career path and the feasibility of starting a master’s degree in a year or two.  This was noteworthy because I could barely keep a handle on everything as it was, let alone adding another major responsibility. I found myself justifying this mindset by saying I was “considering the future” and “being realistic”.

Ha. I was, to put it bluntly, escaping.  There’s a wonderful rush that comes with a new endeavor, the blank, unmarked pages full of possibility. Certainly, the promise of fresh starts seemed a heck of a lot better than the hard, slow work of relearning the everyday rhythms of a stressed marriage or just f*cking dealing with the terrible loneliness of suddenly being my parents’ only living child.

Last night, though, hearing those words about not making serious decisions that can reasonably be postponed during a time of intense emotion finally hit me. It’s good advice. While we’ve got one or two fairly serious choices that do need considered in the next few months, the rest of it can wait just fine. I think I’m going to take a page out of Manning’s book there and just celebrate the victory of being in a relatively happy, stable, sane place before we start exploring those roads.

Want more Microblog Mondays or curious about what it is?  Head on over to Stirrup Queens to read more posts or join in!  Thanks to Mel for originating and hosting. 

The Media And Why Blogging Matters

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One of my biggest pet peeves when it comes to medical procedures or shows on television is watching a patient flat-line and the providers yell “Let’s shock him/her!” Such a moment will have me sitting bolt upright (at best) or actually jumping off the couch (at worst) shrieking “You don’t shock a flat-line! Where the heck did you get your ACLS* certification?!”**

A close second, however, is how often cardiac arrests are successfully resuscitated on TV. A study done in the 1990s showed that around 67% of TV “codes” have a patient surviving, usually neurologically intact. Curious about the real survival rates? According to the American Heart Association, in 2013, 9.5% of adults who experienced cardiac arrest outside of a hospital setting survived to discharge. Of adults who arrested in hospital, the figure is 23.9%. These statistics, I might add, specify only that the person survived until hospital discharge. They do not address neurological status or ongoing health concerns.

Some people may think – and have told me as much – “Big deal. It’s just TV. Stuff gets exaggerated on TV and the in the media all the time.” The assertion about TV and the media is true, but I don’t think it’s as benign as that. I think when people are put in terribly stressful, painful situations and asked to make life-altering decisions, it’s harder to explain why resuscitation efforts were unsuccessful or might not be the best choice in a specific situation. It’s harder to accept death, easier to see it as a failure or something one can outwit almost indefinitely.

This isn’t to say CPR or AEDs/defibrillation aren’t useful. It isn’t to say we shouldn’t keep working to find ways to make that survival rate higher. It isn’t to say we should never intervene in cardiac arrest. It would be fantastic to reach a 67% neurologically-intact survival rate both in hospital and out.

But right now, it’s not reality.

Which pretty much sums up how I feel about IVF and the media.

For what it’s worth, IVF helped us conceive our daughter. We are, in many ways, a success story. I’m not sorry I went through the procedure given the particulars of my infertility and other such factors. My RE (the second/current one) was honest with us about our chances and the known risks. I do think, however, that there are a lot of issues surrounding IVF that need to be addressed. The media is beginning to cover some of the difficulties surrounding IVF, but there’s still a lot of glossing over the painful realities.

IVF is a useful medical treatment for certain types of infertility. It is not magic. It fails a lot – probably a lot more than people who aren’t in either the fertility industry or in treatment realize. According to the American Pregnancy Association, IVF success rates are about 41-43% per cycle for women under 35 and go down from there.  In other words, it often takes more than one cycle even in the best circumstances, something my friends and family members were often surprised to find out because there’s definitely an impression out there that IVF “usually” works.

A study came out in the Journal of the American Medical Association recently, resulting in headlines from the likes of The New York Times about persistence paying off in IVF. The study basically stated that the conventional wisdom when it comes to number of IVF rounds – that after three or four with their own eggs, people should move on to other treatments or methods to resolve infertility – was wrong. Instead, the study said six rounds – and up to nine rounds – could still offer reasonable chances of pregnancy.

So much wrong here that I’m going to largely hand it over to the plenty of other bloggers who have covered many of the angles ably. Dawn Davenport from Creating a Family points out the unease she feels around such a study. Pamela Tsigdinos sums up the real ethical problems inherent in advocating six to nine rounds of IVF. Amy Klein and Dr. Jeffrey Braverman take to task the study itself and the methods used.

From where I sit, if I was reading The New York Times article without being an infertility patient and having gone through IVF myself, I would think that IVF pretty much always resulted in a baby. Even if for some people, it obviously took awhile. I would think that six to nine rounds might be a reasonable number based on the media reports. The researchers from the study certainly give that impression, as this quote from Dr. Scott Nelson implies: “For most couples – and certainly those where the woman is younger than 40 and those of any age using donor eggs – two-thirds will achieve a live birth after five or six treatment cycles. This will take, on average, two years and is similar to rates that couples conceiving naturally take in one year.” Sounds like a reasonable sacrifice.

Except that I have gone through IVF and I have a much better idea of what six to nine rounds entails. The reality is that in a country where IVF is rarely paid for by insurance and people have to save up for each round, the two year timeline Nelson mentions is laughable. It’s also nothing like people who get pregnant naturally and don’t have to take the time off work and live their lives around clinic schedules for the countless monitoring appointments, egg retrieval surgeries, and transfers. I know firsthand living around clinic schedules for a longer term takes a terrific toll on life. While the 65.65% birth rate after this many cycles is trumpeted in the article, there’s barely a mention of the 30+% who will do all of this and still leave with no baby. This is not a small number.

As an infertility patient, media coverage that largely focuses on the success rates of IVF frustrates me. I know perfectly well that we could have walked away from treatment with no baby and it would not have been from a lack of trying or from something we did or didn’t do. It angers me that so many people outside of the infertility community are given the impression that having a baby is something controllable with enough fertility treatment or persistence (again, roughly 34% did not even at the extremes in the study).

In a large part, this is why I keep blogging. I periodically go through the sort of survivor’s guilt questions inherent in having managed to conceive and give birth to a living child after infertility of whether and how I can contribute to conversations about infertility. It’s one of the internet’s finer qualities that smaller, more niche voices have a place in the conversation and are being heard more often. I figure that speaking up to offer a firsthand perspective about the many difficulties inherent in IVF and infertility and an opportunity to counter some of the misguided impressions is definitely reason enough.

It would be fantastic to reach the point where there is as much reason to be optimistic about IVF as the media depicts.  Until then, I’m glad that people in the infertility community are able to correct and discuss these reports, as well as sharing their stories.

*ACLS stands for Advanced Cardiac Life Support

** It really is not ACLS protocol to shock flat-lines. Basically, a shock is done to induce a brief flat-line (asystole). The hope is that then the natural pacemakers of the heart will take over to produce a rhythm that will pump blood to the vital organs of the body. Think of it like rebooting a computer. Rebooting works when something is messed up in the system, but will not work if the computer is not on at all.

If you want to check out more Microblog Mondays posts, head on over to Stirrup Queens to join in !  Thanks to Mel for hosting and originating Microblog Mondays.  

Kneeling In The Mud

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Sifting through my jewelry box for a pair of earrings the other day, I noticed a piece of cardstock sticking out from the disorganized pile of necklaces and earrings that got tangled in transport when we moved and that I’m still sorting out. I managed to separate the cardstock, which had a necklace attached to it. Ah, yes. I remembered this necklace well.

Arthur and I had decided to plan a trip that fell after our IVF cycle last year. We figured that if the cycle worked, we could celebrate being pregnant, and if it didn’t, we’d have something fun planned to help with the aftermath. The weekend that worked also happened to coincide with my 31st birthday. On the way home from our trip, we had made plans to stop in the city on the way home to eat supper and Arthur offered to take me to a little fair-trade shop carrying items by women artisans from around the world there that I always enjoyed.

I was in a wonderful, surprisingly relaxed mood. I had an ultrasound scheduled the next day to check the progress of my pregnancy, I was feeling great, and since it was my birthday, I even had a little bit of gift money I could spend. I looked over scarves, earrings, and purses. What caught my eye, however, was a blue, white, and orange pendant made from china with a silver chain on an upper shelf. I read the card that explained a bit about the necklace and the artist, smiled, and knew I had found the piece I wanted.

About a week and a half later, everything went south, and the necklace went into my jewelry box, forgotten.

It’s not a secret that I’ve been struggling to deal with everything that happened over the last eight months, and really, the past three years. It’s why I’ve been slow or absent with blogging or responding to people lately. That I’ve so keenly felt the dissonance and sadness has been a surprise to me. While I certainly said all the right things – that it would probably take awhile to resolve the infertility even after having a child, that I was just grateful to have my daughter at all, and so on and so forth – it’s shocked me how much I have left to sort through emotionally. I think, deep down, despite all my protestations to the contrary, I did expect having a living child to heal most of the wounds caused by infertility and loss.

Instead, I still struggle with pregnancy announcements. Ultrasound photos that I’m not prepared for have a tendency to send me into intense and unpleasant flashbacks of all those ultrasounds I had with E, concerned voices noting the size of my SCH or the lack of amniotic fluid. Watching women having uncomplicated pregnancies go about the wonderful business of decorating their nurseries, shopping for maternity clothes and joining in the chatter about symptoms have me sighing wistfully and feeling a distinct pang of jealousy.

Since I finally left the hospital with my daughter, I tried mightily to cultivate an outwardly positive attitude about all things pregnancy and childbearing, to smile and be genuinely okay. When that failed, I played more vicious rounds of the pain olympics than I’d care to admit, applied as much guilt as possible to cajole myself out of the grief, and told myself it was time to suck it up. Unsurprisingly, all this achieved was a deeper hole. That’s what led me to search for earrings: another effort to lift the sadness by going through the motions of normalcy.

The necklace is from Japan, made from a shard of pottery pulled out of the wreckage from the 2011 tsunami. The card reads “Beauty from Brokenness” and states “As each colorful shard is transformed into a beautiful treasure, so too are lives being filled with renewed dignity, beauty and hope for their future”.

My world wasn’t rocked by anything as traumatic as that tsunami, but there’s no denying the pain. I stared at the pendant for awhile, recognizing that as beautiful as it is, the piece of pottery it once belonged to is still shattered. Nothing will put that back together.

In a culture that expects grief to be over within weeks of a trauma, that frowns on the expression of that grief, that disenfranchises the grief of miscarriage and infertility, that promises wholeness with enough work, I’m realizing that this simply isn’t the case for me. Making my peace and coming to acceptance is going to be the work of years. Nothing will put my life back together the way it once existed.

There are so many things I’m grieving right now. Some are losses that will reverberate over a long time, such as my miscarriages. Some are more petty, such as my the maternity photo shoot I had looked forward to throughout most of infertility and had to cancel. I’m beginning to understand that in the end, I can’t cajole myself out of that grief. I can’t refuse to feel it. I can’t ignore it or pretend I wasn’t changed by it. I can’t pretend it doesn’t exist. I can’t reason or guilt or force it to go away.

In the end, I hold out the hope that perhaps, like the pottery in my necklace, there will be something new created that is beautiful in its own right. To do that, however, means kneeling in the mud, carefully picking out the shards. It means not trying to fit the pieces back into place, disguising the cracks, and pretending it is whole and unaltered. It means acknowledging the brokenness.

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Want to read more Microblog Mondays posts?  Head over to Stirrup Queens.  Thanks to Mel for hosting and originating.