Glum

Today I don't feel better. I feel sad sad horribly sad and bad and a little bit mad. I guess it comes in waves. We went to my favorite restaurant this weekend but lo! Ther was half the residency celebrating R____'s baby boy, who is to be delivered by c-section in less than two weeks. And of course I ended up sitting beside her in clinic today, and she asked me when Husband and I are planning on children. I told her what had happened. I changed the subject but it was a hard day. And yesterday I felt sad too. When my grandmother asks me if there's any news I tell her it will take months -- if we're lucky. And then I get sad thinking about it. I don't feel like doing anything all day but curling up crying. I haven't even an interest in reading about my patients. I try to force myself to care about them and at least to focus when I'm at work but it's such a struggle...even today I am afraid I should have appreciated that my patient had osteomyelitis and not just soft-tissue infection. Actually I don't know yet that he does have osteomyelitis because I tried to probe to bone with a metal probe but wasn't sure what I felt (having never tried before), and the imaging is pending. But what if I wasn't treating him with appropriate antibiotics? What if I narrowed the spectrum too soon? What if I's my fault he ends up with a BKA? That is completely unacceptable. I should never had been given an MD.

But mostly I just spend most of the day thinking about the baby I had and didn't have and won't have, and the babies I am afraid I won't have, and being sad. Even when I'm interviewing a patient, or examining a urine slide and Dr. J________ is teaching me about tubular cell casts, I've got babies on the brain. I feel tired all the time and nothing really seems like fun. I don't even feel like taking a walk. I feel only like curling up with my childhood security blanket and crying.

At least it will soon be September. September means ACP State Chapter meeting with the amazing, awesome, Thieves' Market (David Scrase rules!) and my best friend is visiting and then it's Rosh Hashanah. I love the new year, the family all gathered together, the start of fall, and of course the feast. And again I will pray that God finds me meritous this year and grants me children. But I'm pessimistic. And I'm angry. I prayed so hard and it brought me only heartache. Another new year without a baby. How many more?

In Which our heroine learns to bury heartache deep inside in order to care for a patient, then learns flexibility in scheduling

It is possible. Even when the heartache is so great that you spend a part of each day curled up with your childhood security blanket staring sideways out your bedroom window at the trees, too sad even to cry (there is such a thing), you can compress the heartache into something small, bury it deep, and do what must be done.

I wasn't sure I could do that until today.

But I can. I did. My first patient of the day was a pregnant woman, 30 weeks along, with three other children at home. She may be induced early for polyhydramnios but still has a good shot at a healthy baby. And it's a boy. I was tempted to ask that someone else take the patient but I didn't let myself. I saw her, took her history and examined her, felt that baby's head and saw hr excitement. I presented the patient to Dr. B_____ without showing a hint of my inner feelings. I didn't even cry afterward although I was definitely in a funny emotional state all day.

Okay, no crying may be because there was no time -- I was pulled from my carefully-requested Hematology Consults elective to fill an open intern spot at the VA on general medicine floors. To be accurate, Mama requested that I be the intern pulled because the senior on the team with an open spot is supposed to be wonderful. I was not geared up for a floor month and I've never been good with change, but I know I'll learn a lot and a good senior can make ALL the difference. And a front-loaded schedule is a blessing.

One piece of advice if you know someone who just miscarried. Especially if it's your daughter, and she can't have children, and she can't even carry them. Don't say to her "It's just a miscarriage." That hurts.

Anyway, I just you to know, dear reader, that you can be horribly sad and still find a way to function. Time moves on. When you are about to lose it, take a deep breath and tell yourself you have full permission to lose it as soon as you get home. You get to have your emotional outburst, it just needs to wait. You can make it through many a day like that.

PS

And regarding my chest roentgenogram: interval resolution of hilar lymphadenopathy, known pectus carinatum, but -- increased ap diameter and hyper expansion? I'm pretty sure I don't smoke or have significant passive exposure. What gives? And what does this mean?

I guess I'm doing better than on Friday and Saturday, but I'm still so sad and bitter and hopeless. I don't think I really knew what psychomotor retardation was until every step became a physical struggle, and lifting my feet? Forget it.

Isn't this ridiculous? I have such a wonderful family and so many wonderful friends, and I have a wonderful career just starting out, and I have a roof over my head and food on my plate. Why do I feel like curling up in a ball with my childhood security blanket and crying?

We did find out the baby would have been a boy. I haven't heard about the genetic testing yet.

I also spoke with the surrogacy agency and they don't have anyone available currently. I must learn to be patient. Considering I am NOT a patient person, this is a challenge.

People keep telling me I will get my happy ending, but I just don't believe it right now. I will go ahead whenever they find a new surrogate (or even two!) but I honestly don't want to get my hopes up ever again. It hurts to much.

But, dear reader, you probably have no interest in my self-centered sob story. After all, there was just an earthquake on the East Coast and I just heard something about a hurricane on CNN, and there are people going hungry and without a home every day.

So why can't I put this in perspective???

It's done.  We met Surrogate at the Maternal-Fetal-Medicine specialist Friday and Dr. K_________ said it was hopeless and also risky to Surrogate to do anything but terminate.  I know that technically this was just completing what had already started.  I know the baby couldn't have survived and I would never want to endanger Surrogate.  But that little one had a heartbeat and now it doesn't.  And it won't.  I know I had no choice but I feel like I killed this tiny 17week2day creature.

Mama and my grandmother tell me this loss is not a big deal, that it's not like losing a live child, that I should move forward and try again and I will eventually have a baby.  My grandmoher had a miscarriage and even lost an eighteen-month-old.  But she knew she could have children and in fact already had children.  Even though we have four embryos left I feel as if I am one step closer to ending up childless.  That's what this means to me.  I know my family loves me and cares and supports me but I feel like they don't understand.  But I also know that I should listen to my grandmother.  She has been through a lot and speaks from wisdom.  And if my dear, wonderful, amazing great-grandmother were here, she would also say to me "Tochter (daughter), life is for the living."

So I quite literally force myself to put one foot in front of the other and keep going.  I'm trying not to break down and cry.  I desperately want to but people keep telling me I shouldn't be so sad, and honestly I'm working or sleeping so I haven't had time to cry anyway.  When I feel I need to I just tell myself I will put it off until I can, and thus I carry on.  Last night was easier than the night before, and tonight is a little easier yet.  I still feel hollow inside and distracted but I guess it will improve with time.  Tomorrow the surrogacy agency is supposed to contact me regarding new surrogates.  I hope they find someone quickly.  I'm open to two surrogates simultaneously as well -- anything to increase the chances of getting a baby/babies.  I hope Surrogate doesn't feel guilty or bad that I'm not using her again. It's nothing she did, and this was NOT her fault.  It's just that I think mabye at her age and multiparity she might be done.  I really hope she understands.

Anyway, I'm sleepy and writing this makes me sad again, so I think I will be done.  Stay tuned for updates from x-ray land; I'm supposed to repeat a chest roentgenogram this week to see what's happened to my "hilar lymphadenopathy."

Sadness, Anger, and Bitterness are poor company but can't be shaken

I want to do nothing, because nothing matters except the little one I am so close to losing.  It's after eleven and I am still in pajamas.  The bed isn't made.  The dishes aren't done.  I haven't watered my orchid.  I don't care.  What's the point of getting dressed and doing all those thing?  Will it get me a baby?  I feel like wallowing in self-pity.

This is what I started writing last night.

Wished-for Child

I have a wished-for child of pen and ink.
In writing I create what I cannot in real life.
And so I have my my darling doll, figments of imagination lighter than air but solid on paper:
Her laugh
Her squeals when we play peek-a-boo
Her big brown eyes that beam when I lift her from the crib.
But the paper never hugs me back.



Wondering

Is this a punishment?
Do I not deserve children?
Am I unworthy?
(When) will my turn come?



I try telling myself we can try again.  But I wish it didn't mean so many months of a setback.  We'll need to find two more surrogates, meet them, arrange contracts...and of course we are limited because they have to come from Illinois so that everything is legal.

If that doesn't work -- I honestly don't know what to do if I can't convince Husband to adopt.  Life without children seems sad and bitter and pointless and endless torture watching everyone else bring little ones into the world.  If not a mother, what am I?  What fills that great black void?  The bottle of oversize potassium chloride tablets left over from when I became hypokalemic?  NO WAY.  I couldn't do that to the people who love me, and suicide is wrong.  Fortunately I'm not impulsive enough to do something horribly stupid.

I want so badly not to be angry and just to accept this all with grace.  But I am burning up with anger, boiling over, want to break things and pound walls and kick and scream like a two-year-old having a temper tantrum.  I don't know what to do with these feelings.  My best friend suggested going to Teavana and buying some really fancy teas and then curling up with Harrisons.  But the only thing that would really make this better is a baby.  And I begin to think that's an impossibility.  At least here's a comforting quote from David Ben-Gurion:  "Nothing is impossible.  The impossible just takes longer."  But how long, God?  And then there's good old Theodore Herzl loosely translated.  "If you want it, it isn't a legend."  If those quotes could build a state from nothing, can they get me a baby?  Because the quote that's foremost in my head right now is "Give me children or else I die."

ה נתן, ה לקח, יהי שם ה מבורך God giveth, God taketh away, blessed be God's name

My exuberance was premature.  So was the rupture of Surrogate's membrances.  Not just premature.  Preterm premature rupture of membrances resulting in oligohydramnios.  They are referring Surrogate to a maternal-fetal-medicine specialist but it looks bad.  I am trying to accept it.  Job said "God giveth, God taketh, blessed be God's name."  I should learn from that.  And I hope one day I can look back and this will be a small grief compared to a life of motherhood.  We do have four frozen kidsicles, and maybe we will find two surrogates and go for broke -- if I can open myself up to heartbreak again.  But then, motherhood is a lifetime of opening oneself to heartbreak, isn't it?  I'm told.  Not a member of that club.

I must learn to bear this with grace.  I'm so fortunate in every other aspect of life.  It'd be wrong to get angry and bitter, and it's ungrateful.  And I know I shouldn't cry when I have additional opportunities.  I should list my blessings again.

A weighty matter

My first post covered most of my past medical history: Turner's Syndrome (xi variant), hypothyroidism, hypertension, osteopoenia.  I may not have mentioned the eye muscle corrective surgery I had in infancy (familial cranial neuropathy), the five (incidentally very painful) corneal abrasions I had, my bilateral tubal myringotomies, or my giant-cell tumor of the tendon sheath.

And then there's something I know I didn't mention: my weight.  I've never been considered overweight by anyone other than me.  I've always been significantly under my so-called Ideal Body Weight of 122 pounds.  But I can't remember a time I didn't feel fat  I remember being a little girl, not yet weighing 50 pounds, and hoping I wouldn't ever weigh that unimaginable amount.  I remember ballet class as early as fifth or sixth grade, feeling so ugly compared to the other girls.  There was seventh grade when I would wipe the grease off fries or pizza at bar/bat mitzvah parties.  I remember in eighth grade reaching one hundred pounds and feeling so frustrated with myself that I had let myself weigh that much.  And let's not even get started on the ballet classes I took in undergrad where half my classmates were prepubescent or barely pubescent and stick-thin.

Basically, you can see how this is the setup for constantly trying to lose weight through a combination of diet and exercise since age twelve or thirteen.  And through a combination of iatrogenic hyperthyroidism, vigorous exercise, and willpower I finally did in the first two years of med school.  I made it back down to one hundred pounds and then held steady at 103-104  after discontinuing the diuretic that made me hypokalemic.  I gained a few more pounds over third year but got back down to 104.

I know it makes no sense.  A medical student - I guess doctor now -- should theoretically realize that a BMI below 18.5 is associated with increased morbidity and mortality.  But I have the ability to hold two completely contradictory ideas in my head.  And so I continue to exercise and restrict my diet.  And it upsets everyone around me: my parents, my grandmother, my husband, my doctor/mentor...

They keep telling me it will make me unhealthy.  But it's not as if I intend to go really low.  I don't want to weigh less than one hundred.  I just want to get down to one hundred pounds and stay there.  And I felt fine when I weighed one hundred pounds!  I could jog six miles a day!

It's not that I am complacent.  Causing grief and frustration to people who care about me, worrying my amazing wonderful grandmother and my sweet caring husband and my mother who does so much for me, is wrong.   Even my doctor/mentor tolerates my melodrama without complaint or showing how sick of me she must be, and gently urges me to build up my reserve so that I can better handle infections and -- most importantly -- so that I am prepared for the wonderful stress of motherhood.

But instead of listening to anyone, I keep at it.  I don't understand.  And I'm not asking for sympathy or pity.  I'm simply telling the story and thinking aloud, metaphorically speaking.  A simple URI last week completely knocked me out and you'd think that would be a clear message.

Why is it my appearance is so important to me?  Why can't I listen to medically sound advice?  Will I ever change?  People always say children change everything; maybe that will do it.  What if I never change?

I'm not even sure exactly why I decided to post this chronicle.  I don't want to change right now and I don't want to think about changing in the future, but I feel tortured about what I'm doing to people who care about me because I know it's wrong.  And my dilemma is completely of my own design and I have all the power to end it if I were to choose to do so.   

Incidentally, there are only ten or eleven case reports of girls with Turners Syndrome and Anorexia Nervosa.  so if I would actually accept the diagnosis somebody could maybe get a publication out of me.  Has anyone ever written a case report where he or she is the patient?  I am curious

A good book and a good cake

So our heroine has again contracted bronchitis.  Fortunately, she is not scheduled to work again until Wednesday night.  Instead there will be much tea and Kleenex.  Also there will be sending of parentage forms to our lawyer in Illinois.  These are supposed to be done by around week twelve, but I'm superstitious....anyway, they are going out today.

Theoretically, it wouldn't hurt if I did a little academic reading as well.  But fiction is so much more fun!  I'm reading the House of God by Samuel Shem.  It's engrossing  I can identify with parts of each character.  It's also fun sort-of reading about medicine without feeling as if I must commit to memory every factoid.  The feelings of incompetence, elation when something goes right, inability of outsiders to understand, frustration when being forced to deliver futile care...all so real!  I was so wiped out from this URI that it took me an hour to muster the strength to get up from the sofa and shower, but I kept reading until Husband came to bed because the book has me hooked.  I didn't realize how much I miss that feeling of being totally engrossed in a book.  Sometimes I will say I wonder if I shouldn't have been a literature professor.  I feel so much more competent when I am in the literary arena than the hospital.  But I love patients and hopefully (please?) the competence will come with time?

Otherwise, how about a delicious cake recipe?  this one is named the Tzvia cake, because a lady named Tzvia taught us to make it.

3 eggs
1 cup oil
1/2 cup orang juice
almost 2 cups sugar
2 tsp baking powder
2 cups flour
fruit - can be frozen berries, cut plums, almost anything works -- but if you are using apples then I recommend sauteing them in some butter and brown sugar and vanilla

Directions:
Preheat oven to 355 and grease a loaf pan
Mix everything except the fruit together -- you don't even need an electric mixer.
Pour cake batter, then fruit, then cake batter, then fruit...
Bake for one hour -- may even need a little longer.  The crust will be crispy and brown but shouldn't really be burnt.

Enjoy!  Especially delicious served hot from the oven with a scoop of vanilla ice cream on top!