Currently Reading: Wolf Hall

I’ve had Hilary Mantel’s award-winning novel Wolf Hall on my bookshelf for years.  With Tudor history as an interest (my pen name here derives from one of Henry VIII’s queens) and this being one of the most hailed historical fictions about the period in recent years, it seems strange that I’ve never gotten around to reading it, but as I progressed through infertility, it got a bit too pointed to read about women who suffered awful fates for not bearing the required (male) child.  With the final book in the trilogy having recently come out and my last infertility treatment finished, I decided to give it another try.

The novel centers on Thomas Cromwell, one of Henry VIII’s chief ministers – more what I’d term one of Henry VIII’s “fixers”.  Cromwell, a clever lawyer most famous for his take-down of Anne Boleyn, is a tricky historical figure typically portrayed as a villain (often in contrast to his contemporary, literally canonized as a saint by the Roman Catholic Church, Sir Thomas More).  Like More, Cromwell paid for his service to Henry VIII with his head – though Henry later regretted Cromwell’s execution.  Mantel, instead of focusing on More, uses her imagination and history to rehabilitate Cromwell’s reputation, making him a sympathetic, multi-dimensional character.

Mantel has written about her own infertility and endometriosis, most notably in her memoir Giving Up the Ghost.  It’s incredibly fascinating to see how she tackles having, losing, and wishing for children in this story that turns so sharply on birth and heritage.  In modern times, when having children is (sometimes) more of a choice one way or the other, Henry VIII is sometimes seen as a bit of a curiosity in his desperation for a male heir.  Historically, however, Henry’s own father Henry VII won the crown of England through combat, defeating Richard III in the Battle of Bosworth.  Henry VII (Lancaster) then married the leading lady from the rival house, Elizabeth of York, to try to bring together the warring factions.  Civil war was not a particularly distant memory, there were still members of royal clans in England with some claim to the throne, and Henry VIII was well aware that war was a very real possibility if he did not produce a male heir.  Mantel keenly allows all of these to intersect early on in a meditation from one of Henry VIII’s cardinals, Thomas Wolsey, speaking to Cromwell: “’Imagine this.  You are a man of some thirty-five years of age.  You are in good health and of hearty appetite…your joints are supple, your bones support you, and in addition you are King of England.  But.’  He shakes his head.  ‘But!  If only he wanted something simple.  The Philosopher’s Stone.  The elixir of youth.  One of those chests that occur in stories, full of gold pieces…Now the chest of gold I have hopes of, and the elixir, all the rest.  But where shall I begin looking for a son to rule his country after him?’”

It is possibly one of the best bits I have ever read on the difficulty of not having the children one wishes.  Mantel sums it up so neatly, pointing out that even magical elixirs are easier to come by than children in some situations.

The novel never rushes anywhere – at around 600 pages, it’s not a quick read – but Mantel has a way of mixing descriptive passages with short spurts of action.  She lingers on sumptuous fabrics as well as gory executions, inviting the reader to witness both.  Many characters given more sympathetic portrayals elsewhere in fiction, in this novel are presented in a less than flattering light – More as a torturer of innocents, Katherine of Aragon as a deeply stubborn woman who refused to yield, and Anne Boleyn becoming a shrill and deeply unpleasant woman*.  All this carefully contrasted to the coolheaded Cromwell, who, in addition to his historically recorded calculating nature, given a genuine love for his children, his wife, and his wards.

It’s a fascinating reversal and goes to show how history and reputation often depend heavily on the writers in charge.  While Henry VIII’s divorce from Katherine of Aragon and desperation for a male heir was a major reason for Henry VIII’s break with the Roman Catholic Church, another component of that schism was the wealth of the monasteries and RCC in England.  Henry, having spent his parsimonious father’s wealth and perennially broke, got the almost irresistible chance to take over the immense properties when he declared himself head of the church.  Cromwell was instrumental in making that happen.  Mantel takes Cromwell from a ruthlessly greedy schemer to a believer in church reformation that sees the monasteries as places of corruption, preying on the faithful.

Even though there are no mysteries or spoilers in that all is well-worn history, with her choice of one of the most unlikely protagonists in the historical record, Mantel keeps the story fresh.  I just purchased the next installment, the ominously titled Bring Up the Bodies, covering the fall of Anne Boleyn.

* Anne Boleyn is a tough historical character to tease out accurately in terms of personality.  Historical records tend to see her as either the martyred, saintly mother of Elizabeth I and tout some of her better deeds, particularly her well-known strength as she came to her execution, or they tend to see her as a terrible woman who sent good people to their deaths, broke the Church, and generally a nasty, temperamental piece of work.  The best source material for Anne’s life come from the ambassadors to the court, particularly Spanish Ambassador Eustace Chapuys, who was a staunch supporter of Katherine of Aragon.  There’s no denying that Anne did alienate key supporters and appears to have been quite cruel toward her step-daughter, Mary.  It’s hard to say, though, whether or not some of the other behavior attributed to her was quite as malignant as certain accounts give.  There’s also very little doubt that Anne was murdered on trumped-up charges, and as Chapuys notes, showed great courage, admirability, and grace in the face of her impending death.  Perhaps Anne was all of these things. 

That’s My Story and I’m Sticking To It

In my 20s, I attended a fair number of baby showers and pregnancy/childbirth-centric events.  It’s like a bad take-off of the Jane Austen line, “It is a truth universally acknowledged…”…that if you are a married woman in your 20s, you are interested in conceiving/pregnancy/birth.  As someone who was at best ambivalent about having babies (oh, the irony) at the time and more focused on going back to school, I found this emphasis frustrating.

When I arrived at 30, suddenly in a tearing hurry to have babies and getting into increasingly expensive, painful interventions that seemed to fail at every turn, the amount of social pressure turned into something far darker.  While there are areas of the US where women in their 30s having first babies is the norm, where I live, I was one of the oldest people in my peer group married with no kids.  Most of my friends have older kids, including a kid who is a teenager currently.

In the throes of infertility, I quit going to baby showers.  I stayed out of heavily female spaces because it felt like pregnancy/childbirth stories came up a surprising amount as a bonding activity.  I figured one day I’d get wherever “there” was to feel emotionally secure enough to start attending again.

I had the kids.  And then something strange happened: I still don’t belong.  Not really.

There’s more room for sharing of “less than optimal” experiences now than perhaps there once was, but there’s still a pretty heavy social price for relating certain parts of stories.  I’ve personally primarily experienced this in regards to miscarriages/pre-viable PPROM/NICU – so that’s what I’m writing about here – but I also know this happens in some very difficult ways in the infertility community as well for people for whom treatment doesn’t work or adoption doesn’t happen (because this isn’t my story to tell, here is an excellent blog post on that subject, as well as here).

The first time I naively waded into a discussion after my older daughter was born, I simply spoke part of the truth: that I’d been in the hospital for quite some time after my water broke at 21 weeks, the doctors thought the baby wouldn’t make it, I somehow stayed pregnant until 28w4d, and E was born, spent awhile in the NICU, and was now doing pretty well.  Never mentioned the infertility/IVF/miscarriages or the messiness of the subchorionic hematoma/hemorrhages.  I actually watched someone’s mouth drop open.  People weren’t sure what to say.  There was some shuffling and looking down and the subject got changed.  It wasn’t the last time this happened.  Eventually, I started being a lot quieter during these conversations.

“It’s like I’m Stephen King giving a speech at the romance writer’s convention,” I once quipped to Arthur.  I’ve also heard more than once complaints about how people love to tell expectant women the worst stories about infertility/pregnancy/childbirth and scare them.

Obviously, there’s an element of knowing your audience here and being polite or sensitive.  I don’t tell anxious pregnant women my story because of this, because they’ve got enough concerns going on.  There are times that people can’t handle certain stories and I get that.

But other times, there’s an element of silencing.  Stories that are too uncomfortable and too taboo to tell out loud.

As I was reading Sarah DiGregorio’s book on prematurity Early, a passage helped crystallize the vague sense of not-belonging I’ve felt at times: “I also didn’t want to be the bearer of dark information, and I couldn’t imagine how I would participate in ‘normal’ conversations about my baby.”  DiGregorio also notes that “The emphasis on ‘natural’ birth that is meant to be empowering can be painful for those of us who needed every unnatural intervention to get our babies (and/or ourselves) out alive.”

I hear that.

I know that I’m (thank goodness, as I wouldn’t wish this on anyone else) an extreme outlier to plenty of statistics.  Of people who struggle with infertility,less than 5% go on to use IVF according to the ASRM.  Subchorionic hematomas are one of the most common reasons for first trimester bleeding, but very few are anywhere near as problematic as mine turned out.  Periviable PPROM affects only around 0.4% of pregnancies.  While preterm birth is an enormous problem in the US, only a little less than 2% of all births and around 16-20% of preterm births are before 32 weeks’ gestation.  In other words, my experiences are definitely not the norm. I don’t think policies or procedures or public health should be based around women like me.

But the suggestion that anyone can (fill in the blank: get pregnant without intervention, get pregnant with intervention, prevent a miscarriage, give birth without certain interventions, prevent a c-section, etc.) has the weird effect of sort of erasing people like me who don’t fit into those narratives that we are ultimately in control.  At times, I’ve found it also can have the effect of almost turning my story into a spooky fairy-tale, the thing that lurks in the shadow, the uncomfortable specter at the feast.

It’s a tricky thing: I want women to be empowered to seek answers and have authority over their own bodies, I want to see fertility treatments covered by insurance but not hailed as ‘the’ solution to infertility, I want as many miscarriages as possible prevented but women not blamed for miscarrying, I want to see unnecessary c-sections curtailed and more choices for women but also the understanding that c-sections can be life-saving preserved, I want better public health to help prevent as many pre-term births as possible and also better NICUs/treatments for those that happen anyway, I want campaigns of information that can help people avoid bad outcomes but don’t ‘other’ or shame those that don’t fit or have less than optimal outcomes anyway.  I did nothing wrong and yet so much went sideways for me.  There was no extra prenatal care or information that would have helped me, there were d*mn good reasons I had c-sections, and I get very tired indeed at times of explaining why (fill in the blank) would not have prevented this, the suspicion that I had to have done something to make this happen because surely these things are preventable?

I don’t know the answer here.  I don’t know how we make space and genuine understanding for all of these realities.  Telling stories is a starting place, I suppose.

Something More

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A friend posted about the latest study making the rounds regarding miscarriage/loss and the impacts on those who experience it.  Basically, the study showed that in both the short and long term, women who experienced loss had fairly high rates of post-traumatic stress, anxiety, and depression.  I’ll admit that I myself, while very much appreciating the fact that the study (finally) validates my own experiences, rather side-eyed the amount of surprise the researchers expressed at how high the numbers came out.  Clearly, they haven’t spent much time around people going through infertility/ectopic/miscarriage/loss, because this seemed pretty obvious to me.

My friend, however, noted that the article talks about how the researchers “hope the findings will encourage women to speak more openly about miscarriage and ectopic pregnancy and help others understand the impact of early pregnancy loss on women.”  I checked it out a little further, and the article states: “Having a greater appreciation of the results hopefully with enable friends, colleagues, employers, and family members to better support women and their partners going through a pregnancy loss.”  As my friend noted, there’s very little about better helping women connect with mental health care or how the medical care of these conditions might change.

Peer support is a marvelous thing.  Openness is a marvelous thing.  I mean, I’m here, blogging about miscarriage and infertility as are a lot of others.  I have no trouble talking about my own miscarriages in real life.  Peer support and community and blogs got me through some of the darkest moments of this thing.  Peer support and speaking out and awareness matters.

But it’s not the only thing that’s necessary here.

When I was pregnant with M, I almost lost my mind through the first trimester.  Unfortunately, that’s not hyperbole.  I was anxious beyond all possible belief and struggling through panic attacks regularly.  I had intrusive flashbacks to my first pregnancy – a missed miscarriage – that left me in a terrible place.  Add in a subchorionic hematoma that also left me bleeding/spotting semi-regularly, which caused a great deal of concern thanks to my third pregnancy, and I was a total wreck.

I’m incredibly fortunate because my OB, who knew my history, had me to come in weekly through the first trimester to check for a heart beat until I could pick it up on my home doppler, then feel movement.  I do not think I could have coped and functioned otherwise, because that’s how extreme the anxiety had gotten.  I also had access to mental health/therapy, which helped at other times.  Peer support is wonderful, but I needed access to professionals and a different plan of care than the current standard.  I had it, but I’m also pretty certain I’m an exception, not the rule.

To this day, I still get an absolute pit of fear in my stomach when people announce pregnancies, separate from any sadness/jealousy left over from the infertility because I know how much can go wrong.  I breathe a sigh of relief when people pass 13, 24, 28, 32, 34 weeks’ gestation.  Ultrasound pictures, among other triggers, can still send me into flashbacks and intrusive thoughts/memories or occasionally outright panic attacks.  Part of me hates to acknowledge that despite the fact that I’ve had some good outcomes, I still struggle (yep, therapy – among other things – are a part of my life currently).

What I’m saying is, how does the medical system need to change to adjust for this study (and I say this as someone who has a career in healthcare, so this is not an abstract question for me)?  How do we connect people better with mental health professionals?  Do we need to see more follow-up appointments?  Better screening tools?

How can we encourage women to speak out about their experiences without making it a mandate, another “to do” for people already in pain?

I sincerely hope that this study is a call for new goals/initiatives/treatment plans, well beyond what currently exists, not only awareness.

This post is a part of Microblog Mondays.  If you want to read more or participate, head over to Stirrup Queens!  Thanks to Mel for originating and hosting. 

The Odyssey

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Last year, Arthur and I left our long-time church denomination after the worldwide conference voted to make a decision we simply could not abide by.  After we took a couple months off entirely and spent Sundays making waffles, reading, and just being generally lazy in the best possible way, we knew we wanted to work on finding a new church more in line with our values.  Eventually, we landed and started putting down roots.  There’s plenty that churches and denominations have generally in common, and while this is a new tradition to us in many ways, it’s also very familiar.  There are still occasional moments, though.

Listening to the organ play the intro to one of the communion hymns yesterday, both Arthur and I recognized it immediately.  It’s a particular favorite of mine, to the extent that it’s the music I walked down the aisle to when we got married, but as I looked down at the words, I realized they were definitely not the old, familiar ones I know by heart.  The closing hymn was the reverse: I knew all the words, but they were not set to the music I know.  Both of us laughed afterwards – so close, and yet so far!

Such it is right now in this period of transition generally.

I think one of things that is alternately frustrating and comforting is that after everything (waves hand generally at the last seven or eight years) the building blocks of who I am are still the same.  I’m still introverted, stubborn, bookish, prone to wrath, able to laugh most days at the absurdity of life.  The bedrock is there.  The circumstances have changed fairly vastly, the worldview expanded, perspective changed, but I’m still, well, me.  Also, in some big ways, not.  The familiar sitting in such close company with all the new is a little disconcerting.

Perhaps one of the things I expected after the everything was a personality transformation into something entirely different.  Something that overcame my weaknesses.  Something that transfigured my strengths.  Something motivational.  Something fabulous.  And, perhaps, an ending, a there, a destination.

Instead, as one of the characters says to the protagonist in the novel (This Tender Land  by William Kent Krueger) I’ve been reading and re-reading, “You believe you’ve been looking for home, Odie.  This is where your belief has brought you.  That doesn’t mean it’s the end of your journey.”

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

The Stories We Tell Ourselves

After the FET didn’t take, Arthur and I had the usual picking up of the pieces and trying to reformulate them into something that resembles a whole.  As always, this involves a fair number of discussions.  Most of the time, even when we’ve disagreed on specifics or details, we’ve generally come to a compromise that both of us are reasonably okay with going forward.  If we’re not on the same page, we’re usually in the same book, as it were.

This time, it turned out, we were decidedly in different books.

We both were in wholehearted agreement that we’re done with ART, but beyond that was where things broke down quickly.  I was on team “let’s see where the chips fall for at least a few months and then move on if nothing happens”.  Arthur surprised me by declaring that he was on team “Done.”

Well, there’s really no compromise possible on something like that – either we’re open to the possibility of another child or we’re not.  The odds would not be in our favor on conceiving and/or carrying to live birth at this point, but it’s possible.

After a several skirmishes leading to outright arguments, the short story is the only realistic conclusion for us has been reached: we’re done.

~*~

I’m not going to pretend that I’m at peace with the whole thing or deny that a part of me is still harboring a small hope that Arthur might change his mind in the next month or so, but I also can’t say I don’t see Arthur’s point in this whole mess.  It’s been a long 7+ years and honestly, we’re both exhausted, physically and emotionally.  ART demands an amazing amount of energy.  Beyond that, I’ve been doing what amounts to a rotating shift for 4+ years now which messes up my sleep cycle (2 consecutive night shifts at work, then up during the day the rest of the week) and while 37 is by no means old, it’s also not the same as being in my 20s.  Arthur and I are often like ships passing in the night since he works a more traditional 5-day a week 8-5 job.  E goes to kindergarten in the fall of 2020, heralding a new phase in life.  M will probably start another day in preschool at that point.

Some of it, though, I think, is the narrative of “try harder” still echoes in my head.  Part of me feels like I’m giving up.  Like if I just kept pushing, trying, hoping, I could somehow still the voice that tells me that it’s possible and I have to do just this one more thing.  It’s the d*mn shadow that I’ve battled throughout the whole process – the one that urges scorched earth tactics, that says that until everything is completely destroyed, it’s not enough.

It’s a liar.

I know that.  I know that.  I’ve spilled volumes of word processor “ink” on this myth myself and read plenty of other essays/blog posts/books that urge the setting of boundaries and the importance of maintaining mental, physical, and relationship health.  It would have been enough no matter how the whole thing ended or at what point we stopped.

And yet, it’s surprisingly hard to push back from the table and say “no longer”.

~*~

I can’t change the facts, but I have been working on re-framing the story I tell myself.

In the last few weeks, the story in my head has gone something like this: I could try harder.  We could achieve this, even in spite of my history.  We could overcome the hardships of possible miscarriage, a geriatric pregnancy, and a failed FET cycle if I was tough enough to keep going.

Instead, I’m trying this on for size: Infertility sucks.  We fought incredibly hard to the absolute best of our ability.  We are beyond fortunate in so many ways.  Setting boundaries and respecting limits are good things.  Time to heal the wounds and move forward enjoying life.

I’ve written about this before, but I keep coming back to author Bill Bryson’s ending to A Walk in the Woods: Rediscovering America on the Appalachian Trail.  Near the end, Bryson has a conversation with his companion Katz.  Bryson is a bit disappointed that they didn’t make it as far hiking as he envisioned.  Katz, on the other hand, has an entirely different perspective:

‘“Anyway, we did it,” Katz said at last, looking up. He noted my quizzical expression.
“Hiked Maine, I mean.”
I looked at him. “Stephen, we didn’t even see Mount Katahdin.”
He dismissed this as a petty quibble. “Another mountain,” he said. “How many do you need to see, Bryson?”
I snorted a small laugh. “Well, that’s one way of looking at it.”
“It’s the only way of looking at it,” Katz went on and quite earnestly. “As far as I’m concerned, I hiked the Appalachian Trail. I hiked it in snow and I hiked it in heat. I hiked it in the South and I hiked in the North. I hiked it till my feet bled. I hiked the Appalachian Trail, Bryson.”
“We missed out a lot of it, you know.”
“Details,” Katz sniffed.’

 

We hiked the darned trail through infertility.  We hiked it through snow and heat (especially not fun when a cycle demanded being at the RE’s office, then an hour away over icy roads).  We hiked it through cancelled cycles and miscarriages and negative pregnancy tests.  We hiked it through bills and insurance fights.  We hiked it through joy and devastation.  We hiked it through an allergic reaction and Lupron and injection after injection.  We hiked it through ER visits and SCHs and c-sections and a long hospital stay and NICU.  We were enough all along, both seven years ago and now, no matter how this thing ended.

That’s the story I’m going to work to keep telling.

 

Baking

Flour.  Salt.  Yeast.  Water.

I found myself pulling out the big stoneware bowl today.  Measuring, stirring, watching as all of it blends into crumbs and then into something more cohesive.  Turning the dough onto the counter, sprinkling it with dusting more of flour, starting to work it, pressing my fingers deep into the sticky lump.

Knead.  Fold.  Turn.  Repeat.

It’s a sort of miracle how the dough stretches and becomes elastic, fragrant with the yeast and the rosemary I added for flavor.  Kneading is a soothing rhythm, something I’ve done since childhood when I first learned the secrets of baking.

I suspect there’s a reason so many cultural and religious traditions center around food.

My father-in-law called yesterday to let us know that Arthur’s grandmother passed away.  We saw her at the beginning of October.  Even at 101, she was steady, sharp, and engaged.  It was a gorgeous day, we all went for a walk around the swan pond, she gave the kids ice cream, candy, and cookies, and we had a lovely visit.  The day before, I’d had my start-cycle appointment.  The day was bright with literal sunshine and a lot of hope.

One of the things I’ve grown to detest about the early stages of grief is the howling numbness, the void where something once belonged.  The holes, as it gets further away, don’t disappear, but there’s something around them, substance that grows into something steadier.

I can’t do anything particularly practical other than basic adulting right now, because it’s not mine to do, it’s already done, I’m physically exhausted, or I just don’t want to today.  We wait for word on the funeral arrangements.  I think about the pile of baby stuff in the basement.

So, I’m baking bread.  Because it’s what I can do.

I anoint the dough with oil.  Throw it back in the bowl, cover it, put it in a warm spot.

Rest.

Rise.

Rising to the Occasion

I sat down after the cycle failure last night and took inventory of all the myriad emotions swirling through my head.  There was one discordant note that stuck with me: that this ending had come with no final input from the RE that really has been excellent through so much of this process.  It seemed so out of character.  I was so jarred by it that two o’clock in the morning found me awake, staring at the ceiling, aching and angry.

Most of the overall situation is fairly inevitable and unfixable – I cannot change the outcome of the cycle, I cannot change the past seven years, and I cannot change the fact that big decisions lie ahead.  Infertility yanked the illusion of control out of my hands when it comes to reproduction and really, most of life.

But I could hunt down this one small loose end and try to tie it up.  I could express my feelings – bewilderment, sadness, shock that this final phone call with the nurse was the end of the relationship with the clinic and doctor who had really seen me through so much.  I called, spoke to the office manager, and (surprisingly calmly) used my words.

I’m very glad I did.  My RE called me back this evening and we had the discussion that I wanted to have, needed to have at the end of this part of the story.  I’m grateful to him for being open and honest about the various reasons things went down the way they did yesterday and getting the chance to close things on a truly good note.  It was the compassion I deeply needed to hear.

I would be lying if I said I don’t tend towards cynicism far too often in life.  I’m not great at faith or hope or trust in anything from medicine to science to churches to myself to other people to G-d Themselves.  Every now and again, though, I’m surprised and I get a small glimpse of something good.

This is one time where, I’m happy to say, my hope was rewarded and my RE rose to the occasion wonderfully.

I don’t really believe in “closure”.  Like so many other griefs, resolving infertility will be an ongoing process.  Even when we’ve finalized the last of the decisions, I suspect there will be pangs that pierce me at the most strange and random moments for many years to come.  Infertility will no longer be one of the major, ongoing parts of my life, but it will always be a part of my story.

That being said, on this one part, I was able to have a moment of genuine resolution.

Right now, for me, that is a victory.