Finally Arrived

The Good vs. The Bad

The Good:

• I lost 4 pounds this week, for a total of 6 since joining WeightWatchers.  14 pounds to go!
• Things are looking much better at work for me career-wise. Good things will happen come Jan. 1 (I dare not give details in case someone from work finds this blog.).
• I received my brochure for the No. Cal. RESOLVE conference, Options 2005,  on Oct. 29.  It looks great, with tons of sessions on IVF, donor egg, adoption, surrogacy, etc...  If IVF #3 fails, you'll find me taking notes in the adoption sessions.
• I feel a lot healthier since I stopped drinking the soda and eating all the sugar. 
• I ran 4 miles on Monday; slowly getting back in shape.
• I've updated my blogroll so that it displays all the blogs that I am currently reading with Bloglines.

The Bad:

• Katrina: my grief at all the lost lives, and my anger at FEMA for fucking this up royally.
• IVF #3 is going terribly.  Looks like we'll only get one, possibly two, eggs.
• I applied to volunteer at the Women's Community Clinic in San Francisco, but, sadly, they rejected me.  :-(  And they won't tell me why.  I didn't even make the cut to be interviewed. I'm very sad because I think I could have really helped them, and I very much want to do some work with clinical exposure in women's health, especially since my backup plan is still in force.  Unfortunately, these opportunities are hard to find given the new privacy laws.
• I miss InSpring.  Where has she gone?  Not knowing what happened to her makes me feel lost, like a good friend has just disappeared.

If I Were The RE...

If all fails on the baby-front, I hope to apply to medical school and attempt to become an RE. If life takes me in this direction, I do not want to forget what it was like to be a patient.  So, I am making this list of things I will or will not do if I were the RE. 

I'd appreciate it if you could contribute your ideas as well. Please!

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Sensitivity and Delivering Bad News

I will instruct my staff to not bring up Donor Egg with patients unless the patient does. Any suggestions that the patient might want to investigate donor egg will be made by me.

I will have a policy requesting that children not be in the waiting room unless the parent truly has no other recourse. I will request that parents with children keep a low profile. If I can, I might even have a separate waiting room.

I will not have photos of babies all over the office or in all my marketing literature.

I will not walk out on a crying woman without trying to comfort her first.

I will have my nurses call my patients promptly with blood test results. I will instruct my nurses to READ the chart before calling so they know whether a negative beta is a bad thing, or a good thing (recovering from a miscarriage), so that they don't congratulate someone who is miscarrying.

I won't have parenting or pregnancy magazines in the waiting room. In addition to the usual women's mags and celebrity news, I'll also have some news magazines and other periodicals that appeal to men.

High FSH / Poor Response

I will be "High FSH" friendly. I will accept all women that want to try IVF under age 48, even if it negatively impacts my success statistics, but make sure they are fully aware of the realistic chances of success.

If the patient only produces a few follicles during a cycle, I will leave the ultimate decision on whether to cancel the cycle up to her and her husband. I will make sure they understand the costs and risks, but will proceed if they still wish.

Be Organized & Communicate Early and Often

I will provide a detailed schedule to each patient with deadlines for everything.

I will give patients printed copies of their lab results that they may keep for their own records.

My information packet will contain names, phone numbers, and web addresses of all specialty fertility pharmacies with whom patients have had good experiences.

I will clearly publish my recommended policies regarding required sperm quality to avoid ICSI, number of embryos needed for PGD, maximum number of embryos transferred, maternal age cut-offs, etc...

I will maintain an informative website with PDF copies of all forms, policies, etc. I will provide references to detailed, technical information on fertility, like Advanced Fertility Center of Chicago.

I will provide FAQs, in print and on my website, for patients. "How do I find an egg donor?", "How do I find a sperm donor?", "How do I cycle if I live remotely?"

I will let patients send me and nurses questions over email. It will probably reduce the burden of manning the phones in the long run and will allow patients greater privacy.

Holistic Approach

I will work with a psychologist to provide mind/body workshops and run support groups.

I will work with acupuncturists and allow them to give treatments in my office immediately before or after procedures.

Patient Safety & Comfort

I will do follow-up Betas on patients with a history of ectopic pregnancy until there is a ultrasound of an intrauterine pregnancy or a Beta HCG of <1.

I will acknowledge and engage the patient's partner. I will actively involve him/her in all in-office discussions. I will remember that he/she is in the room and will address him/her by name.

I will provide a "specimen collection room" that is clean, comfortable, sound-proofed, and has a locking door. We'll rotate some new magazines/DVDs in each month or two.

Medical Research

I will keep up on the latest medical research and let it influence my recommended protocols.

Financial & Insurance Coverage

I will provide a detailed list of all expected charges per cycle, when the couple signs up. I will proactively tell them about any changes in price.

I will strive to be an "in-network" doctor for several insurance plans.

I will hire an insurance coordinator who is willing and able to followup on claims with both secondary and primary insurance.

I will provide one itemized bill for all services a patient receives per cycle.

My Backup Plan

I have come up with a backup plan.

It is totally far-fetched, about as out-there as a pajama-clad Michael Jackson.  Nevertheless, in the event that I am never able to be a mother, this fallback goal would give me a reason for existing.

If, for some reason, I end up resolving child-free, then I will do everything I can to become a doctor. This will be quite difficult; I will need to go back to undergrad for two years just to complete the pre-med prerequisites, followed by 4 years of med school, 4 years of residency, and 3 years of fellowship studies. That's 13 years of total training.   And that's assuming I'm even able to get into med school and can somehow find the money to pay for it.

As a doctor, I would specialize in either Reproductive Endocrinology or Gynecological Oncology.  Big surprise, eh? Why? Pathetic as it sounds, I find it fun and interesting to read peer-reviewed medical journals, and I've been told I already know as much a second-year gynecology resident. I actually think I might have discovered latent talents late in life; I seem able to remember immense amounts of medical data and my RE has commented that I "think like a doctor." I admire my RE's. I like their analytical approach to problems and the way they keep abreast of the latest research. I want to be like them, but in a more sensitive and empathetic package.

Most importantly, though, the work of doctors is meaningful and important, so unlike my current job or any other position in my soul-bereft industry. In addition to performing the kind of miraculous procedures that could allow a woman like me, without any tubes, to get pregnant, my REs saved my life twice.  Saved my life. What greater difference can a person make to another?

Becoming a doctor was a childhood dream that I gave up late in high school. A brief stint as a hospital candystriper convinced me that I couldn't stand the sight of blood, a fear I've since conquered after 3 years of hardcore infertility treatment.  Then, starting in college, I made a series of half-hearted career decisions driven by my fear of poverty and my pride in being practical. As a result, 20 years later, I find myself so far from where I started, so far from the future I had envisioned for myself, and so far from what I value.  I wonder how I ended up here.

I believe that at my age (34) training to become an MD is incompatible with raising children - the training is too onerous, too long, too expensive, and far too inflexible. I would never see my family. So, if I can become a mother, I will gladly continue in my current career. The most important work in my life will undoubtedly be raising my children. But if I am not blessed with children, my promise to myself is that I will I make my career more meaningful and fulfilling - more like my childhood visions.