Tuesday, April 13, 2010

Encounters of the work kind...

I guess like all of you who blog, there are always posts swirling around in my mind. Then I come here and nothing comes out (surprised?). But I'm going to make an attempt to write about a few things that I have learned on the job that have nothing to do with lipids and heart disease.

In the type of work I do I come into contact with a variety of people all day long. And maybe because we're talking about their health, and I'm their health care provider, they feel like they can open up to me...sometimes divulging things I don't want/need to know, sometimes just sharing, sometimes crying. Sometimes the moments are intense.

Some of my patients I have been seeing for nearly four years. I help manage the complex dyslipidemias at my practice, which means I see the folks who had their first heart attack as a supposedly healthy 35 year old, or the person who has an LDL cholesterol level of 300+ despite being on six different medications. You get to know these people over time, over the years. But patients always seem to want to know a little bit about me and, well, I'm guilty of oversharing (I know--shocker.)

So you know where this is going.

As unprofessional as it may have been in the past, I've told some of my patients that we were trying to start a family.

Usually it would just be in casual way--they would see my pictures of my dogs and ask if we had any children. Four and three and two and hell--even one year ago I might have responded with "Not yet, but we're working on it!"

Obviously they've seen me every six months for four years they're going to notice I've never been pregnant. Some of them gently ask "How is that going?"

I no longer say "we're working on it." I'm getting comfortable with the truth. With hearing the words "We cannot have children" come out of my mouth, spoken by my voice, spoken about me.

I say it, I don't tear up, the words are out there, and saying it every time makes it more real, more concrete, more fact.

Because 81 eggs retrieved, eleven embryos transferred, five IVFs and still no baby had not quite made it real enough as just saying those words out loud.

"We cannot have children."

My patients--God love them--they pat me on the arm and give me a sympathetic look. Some of them hug me and say "I'm sorry." Some of them say stupid things but that's ok too. I'm learning to be more forgiving, to just roll with it.

"We cannot have children." It's a hard thing for people to hear. But it's getting easier to say.

On a different but related note, I also gingerly ask people about their family histories, which has led to me to hear some delightful, some sad, and some just plain heartbreaking accounts of adoption.

"I do not know my family history. And I have hurt my whole life for not knowing anyone who was genetically connected to me--I have felt so alone in this world"--this a response I got early on that left me tearing up as my patient--a middle aged man--teared up, too, the pain in his eyes so deep and raw I could barely keep it together.

Or this:

"I finally connected with my twelve brothers and sisters. I was the baby, the one they couldn't afford to raise." I remained quiet to see if he would continue. "But it was nice to finally meet someone who looked like me, to get a sense of where I came from, to get a small sense of who I am."

Or this:

"My parents are absolutely the people who raised and loved me, no ifs ands or buts. I adore them and they are wonderful people." And then laughing, continuing "But they both have heart disease so I'm glad they didn't give me any genes!"

Of course I also come across cases of infertility. From the patients who tell me that "they had to do infertility to get pregnant" which I then find out means they took one round of Clomid (!) to reading in someone's history of about the loss of triplets at 21 weeks I realize there are a lot of us out there and there are myriad painful ways to experience infertility.

But yet I haven't met myself yet. I haven't had a mid-30s vegetarian with high cholesterol, a thyroid disorder, a wicked family history of heart disease come in, sit down in my office and tell me she can go on medication without also having to take birth control because, come on, she's NOT going to get pregnant. She did, after all, fail five in vitro cycles with nary more than a chemical pregnancy.

If I did meet myself, I guess I'd be gentle with me. I'd probably want to hug me.

Thanks for hanging in for the mindless ramble.


  1. ((Hugs)). This post hit some many levels for me, from your brave statement to the reaction of those adopted. Thank you for sharing.

  2. ((HUGS))

    (Some of those responses from adopted individuals made me shudder.)

  3. It is so sad for me to hear you say "we cannot have children".... =((((

  4. Yup - I've said those words too, and then felt a tiny fraud because I knew I wasn't QUITE done with trying yet. But I was trying it on for size. I'm kind of close to being you - 6 rounds of clomid (BFNs) and an IUI, an IVF and an ICSI (all also BFNs) and 6 very early losses (earlier in my reproductive career!). I have some interesting medical issues - low thyroid, PCOS, insulin resistance, high blood pressure and a family history of high cholesterol and heart problems. Like you, there are medications that I could take which would control some of these much better than what I'm on now, but they won't let me take them till I'm totally done with fertility treatment. I would love to meet a healthcare professional like you - the sharing, while some might see it as a little unprofessional, makes you seem like a human being who understands what it is to be on the other side of the healthcare divide. I wish more healthcare professionals would share a little of themselves - my BP consultant shared with me that he and his wife did IVF unsuccessfully and it immediately turned a pin-striped-suited stranger into a fellow human being. Good on you!

  5. This post is so heartbreaking. The effects of infertility are so deep and far-reaching!! My heart aches for you as you come to terms and "go public" with the fact that you can't have children. My heart aches for the man who has felt so alone without a genetic connection. My heart aches for that man's adoptive family who probably wanted more than anything for him to feel connected to them.

  6. Mrs. LC, I wish you were one of my medical providers. Not only because I'd love to know you IRL, but because we both "get it."

    I think it's brave of you to share this still very tender and aching part of your soul with your patients. It's really difficult. Even though I've become quite comfortable sharing about my MRKH with my various physicians, it still stings every time one of them makes an ignorant or thoughtless comment.

    The conversations you've had with your patients about adoption are powerful.

    It's my hope for you that one day you'll be able to show off a picture of your child in your picture frame, no matter how that child came to be.

  7. I'm still waiting to utter those words in public...but I'm getting closer.

  8. Man... I know what you mean about having broad shoulders and hearing things about patients that break your heart for them. I think it's only natural to share a few things about yourself, after all they have to divulge some of their less than shiny history, so it helps to make a connection with you to know that the "professional" across the desk is a human being too!
    I bet you're an AWESOME health-care provider. Not that I want to NEED your services, but I would love to have you helping me!

  9. i dont have anything clever or exceptionally comforting to say. just that im thinking you and im sorry things didnt turn out the way you (we, so many of us) thought they would. and hoping that when one door closes another opens. xoxo

  10. I'm glad you brought this up. In my practice, I have seen a lot (that's what being the female provider there gets 'ya!) of G0P0 on the charts for the well-woman exams. Sometimes they talk about it- infertility, failed treatments, unable to afford treatments, adoption, not having any children etc.- sometimes they don't say anything, just nod to confirm the information. I always wonder about their story. It has just made me even more aware that YES infertility does exist, more than we think, and it is very complicated and multilayered. Part of me just wants to ask so many questions, but I only dare if they seem open to talking about it. Your story has certainly made me more aware and a better provider for it! It still gets me though- that brief look that passes across their face- it's all too familiar and it's still hard to see it knowing that their heart has broken over and over too.

  11. Wow, powerful post. I have a lot of respect for those who serve in the medical field. I don't have the stones for it.

    I think it's nice that you share sometimes. During my last pap smear, my Dr opened up to me about having done four IVF cycles, two with Donor eggs. I was so grateful that she shared that with me. Though I wonder now how easy it was for her. We both teared up a bit.


  12. Beautiful post. Hug from Ireland :)

  13. Without even knowing you IRL I know you are amazing at what you do and your patients are so lucky to have you.
    I hope the sun is shining on you today.

  14. Wow. Insightful. Beautifully written. Hard. Made me think of a student of mine who last week, out of the blue, said at the end of class that she was going out of town that weekend to meet her birth mother, who apparently lived just 1 hour away from where the student (now 20) grew up. She seem so full of hope and I was happy for her b/c she'd mentioned this before. But my first question (asked gently) was: is your mom okay with this? And with great sweetness, my student looked up at me and said "my mom helped me find her." And everyone seemed to be excited about the new experience they were entering into.

  15. This was very hard--and boy do I want to give you a hug...my head is just swirling with your post...

  16. As always, you manage to be incredibly poignant without even verging on cloying - I love it as writing, but I hate that it makes the sadness feel so real.

    I love the idea of adoption in theory, but practice makes it so much harder - it has to be a balanced set of circumstances so that everyone ends up knowing that it was all for the best. And it seems to work out well often enough. But those unhappy stories are really unfortunate, so I know it makes the whole idea more fraught.

    Lots of sweet thoughts to you and the Mr.

  17. What I'm reading is that you are the whole package. It made me think of a doc at work a couple of weeks ago. He was sitting on a bench in a hallway with his head down. When approached, he divulged that he was praying. He had a patient that wasn't doing well, and he was praying. I've always held this person in high regard, but that confirmed what I've thought for a long time. I don't believe it can ever be unprofessional to connect with your patients. You just never know the impact you will have on one of them because you show your humanness.

    You deserve many hugs.

  18. i was on the ticketmaster website tonight and the verification words i had to enter were "deny embryos"...no kidding! i couldn't help, but save it to pdf...so strange!

  19. I am right there with you uttering those same words. I can hold it together in the moment, but still find those tears when I am able to get away. It's hard enough to hear it from a doctor, but to utter those words is a whole new level of finding acceptance. It's not easy to do...

    We went to an adoption seminar over a year and a half ago made up of pre-adoptive parents, adoptive parents, first moms, and adoptees. We talked on the drive there about how scary open adoption sounded and weren't sure how open we would be willing to handle. And then we heard similar words spoken by adoptees and left feeling completely changed. These are the kinds of things people neglect to consider when they say, "You can always just adopt." So so much to work through...

  20. Well as someone who was adopted, I have to ask that you please not rule out adoption. I had a tough time dealing with the fact that I was adopted during my teen years, but the teen years are an emotional time for most kids adopted or biological. As I got older, I began to realize how lucky and fortunate I was to have the parents that I did. They didn't HAVE to take me into their home and love and care for me the way they would have a child they carried for nine months but they did and because of that, I love them more then life itself.

    As far as my biological parents are concerned, I never looked for them. I feel like if they wanted to know how I was doing they would come look for me, I'm 33 years old and so far that hasn't happened. I'm at peace with that aspect of my life. There are thousands of children in foster care and around the world who would jump at the chance at having parents who love them, even if they don't share the same DNA. Trust me, I was one of them.