Barely promoted

Random bullets of desperation (except without the bullets)

My grandmother died on Wednesday morning, as I was traveling.

Beaker drove out on Friday with Miss T. We held the funeral mass on Saturday.

Everyone who came to the wake was either a neighbor (they all cried) or an old, old, old as in high school, friend of Ricky's.

I am very frustrated by my uncle.

So is Marina. She, however, is married to him. I give it less than a year; she's someone who falls on her feet.

They're going to try to keep the apartment. I give that less than a year, too.

There's a will. It's exactly as hellish as you might expect from my family, particularly since there is no money -- which is all that Ricky wants -- and the only thing I want, namely family pictures, records, and memorabilia, goes to Ricky. He's executor, too. Oh my God.

I'll go back out next week to try to put things in order. Ha.
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It is easy to make excuses for why I was not closer to my grandmother. She was a very difficult person; she held herself back from everyone, emotionally and physically, and she could lash out viciously with little provocation.

For the last seven years, Ricky was living with her, and I found it very difficult to visit -- both because of his presence, and because of how they played off the worst in each other.

But I let that gap grow.

Ricky's high school friends remember me as a toddler running around the House (the one lost in my grandfather's bankruptcy); my grandmother took care of me then. I don't know if my mother was even around much. In her papers I found a couple of poems that seemed to have been written after she'd been caring for me as an infant, and then my mother took me back (one time that ended up with me with pneumonia, my mother back in the hospital). I remember so little of those years -- but my grandmother was the one, I think, the one who was there when I was small.

But after I was taken away from her over and over again -- by my mother, repeatedly, by my foster father trying to keep me, by the custody fight, by my growing up and moving into a wider world -- she was too hurt to let me in again. And I didn't fight it.

The only reason I saw her so often this past year is the IVF cycles. I didn't even go for Thanksgiving last year --- we were going to have a big dinner in January to make up for it --- and then the January cycle sucked and I got depressed and Beaker and Miss T. never came out to New York.
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Ricky seems to believe that my family and I will continue to visit regularly.

On the one hand: what the FUCK?

On the other hand: they all hated each other for years, and what good did it do? Why should I carry on the tradition? (Plus, he could be a really effective anti-drug message, just being his lovely self.)
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I am nominally nine weeks pregnant today. I feel and look pregnant. Nausea, huge sore breasts, a belly that's moderate in the mornings but balloons out through the day. Inability to concentrate. Fatigue. All just like last time at this stage.

It is killing me that it is all, almost certainly, meaningless -- the hormonal effects and physical displacements of a hard-working placenta, doing its best to support something fatally flawed. I can never really believe during the 2ww that the symptoms are meaningless -- but this is multiplied a thousandfold.

Tomorrow I go for my first ultrasound since seven weeks -- that was the bad one. Beaker is driving me, because I can't imagine getting myself home if the news is what we have to try to expect.

Redoubled vigil

At the end of Monday, things didn't seem too bad, all in all. I'd gotten through my grading. As long as I managed to scrape together two midterm exams on Tuesday -- when I wasn't going to be teaching -- I'd be okay at work. I hadn't talked to Weatherwood since Friday, but in the absence of news I assumed things were keeping stable to slight improvement, as they had been. And my boobs were still sore and my eating highly disordered, so I could still pretend I was sort of pregnant, you know?

I slept horribly, though. Shivered down to sleep, then woke up in a sweat: I'd dreamed that Ricky had called to tell me that Nana had died. I lay awake for a long time, then drifted in and out of more bad dreams: nearly losing Miss T. in a train station, over and over.

Then, while it was still dark, the phone rang.

Nana wasn't dead -- and still isn't, so far as I know, as I type on a plane on Wednesay morning -- I just called Ricky from the airport -- but she took a turn for the worse, much worse, in the small hours of Tuesday morning. Her airway is collapsing to nothing. Her oxygen saturation is unmeasurable -- both because it's low and because so little blood is reaching her fingers. She has not been conscious; she shifts slightly, occasionally, and sometimes grimaces. They've given her a little morphine, a little Valium; Ricky tells me the last thing she said on Tuesday morning was that she couldn't breathe. "Her hands are ice cold."

The doctors and nurses have been saying consistently for nearly 30 hours that she only has a couple of hours to live. A priest came in to perform Last Rites yesterday morning.

They do have her on full oxygen now. I think the doctors are trying to decide what a DNR means here; I don't know how much help Ricky is with that. He's been with her round-the-clock since the crisis began.

I spent Tuesday working desperately to get myself free for the rest of the week. I wrote my exams, corralled colleagues into proctoring them, sent flagrantly ashamed e-mail to my classes explaining that I'd be away, here are the arrangements, we'll figure out how to make up the cancelled meetings later... every hour or two I called Nana's hospital room and Ricky told me that nothing had changed. "They are telling us now that it is the TB that's doing all this. Her X-rays looked just TERRIBLE. Now they're telling us that. She does have some pneumonia, but it's really the TB."

I found a miraculous one-way ticket: under $300, to the suburban airport, and only one stop -- 3 hours in Philadelphia! (I could have paid $800 to go via, say, Denver, if I'd been less lucky.) I'll figure out how to get home when -- when it's time to go home.

I scarcely slept at all last night. I'd brought a cordless up to the nightstand, and I couldn't believe it wouldn't ring.

Ricky keeps saying, when I talk to him, that "she's waiting for you to get here, man." He also keeps talking about how "she was the best mother that ever lived, and it was a gift, a gift, that I got to have her for so long."

I won't get an ultrasound on Thursday. I thought about trying to get Cornell to call in an order -- heck, the hospital my grandmother's in has a maternity department, so I could just go downstairs, right? -- but: I know it won't make a difference to the outcome whether I get one or not. So I'm going to wait until I'm home.

Guarded

I talk to either Ricky or Marina every three days or so.

I call Ricky in the late afternoon, as he sits in my grandmother's hospital room. It's an isolation room, with double doors and (I presume) negative air pressure. It feels drafty and she is always cold. If he puts on the heat it quickly gets too hot. He sees climate control, and making sure an appropriate order gets put in with dining services, as what his job is right now, why he's there every day from 10:00 to 6:00.

Marina calls me in the late evening, usually as I'm trying to get Miss T. to sleep. Marina is exhausted. She works all day, then goes up to relieve Ricky at the hospital for a couple of hours. She tells me how frail Nana is, and how bitter; how she tries to refuse treatment, even things that might make her more comfortable. She doesn't think Nana's really about to die -- except for moments every now and then.

Nana is too weak to talk. I haven't spoken to her directly -- my God, since I was there in August, actually. On Thursday night her oxygen saturation went down into the 80's, and they wanted to put on a face mask of 100% oxygen -- she's had tubes in her nose the whole time. She refused, and Ricky supported her. He stayed that night and about four hours later her levels went back up, "after she calmed down some," he says.

They gave her a blood transfusion last week. I think they were planning two, but she spiked a fever after the first, so they stopped.

Ricky has started crushing all her pills into applesauce or pudding, since she was having a hard time swallowing them.

It sounds like the plan now is that once they're sure the drugs are working they'll move Nana into a regular hospital room and keep there until she's stable and stronger. Because of the TB, it sounds like a nursing home is not really seen as an option. When they let her out for real, she'll get 9 weeks of a home aide covered, but no more beyond that.

Both Ricky and Marina tell me not to come now, to protect myself and my family from the possibility of contagion. (They got chest X-rays on Thursday, but haven't heard the results yet. Both will need to be on drugs for a long time regardless, given the positive skin tests.) I never told them I was pregnant, so there's no need to tell them that soon I won't be.

Direct flights from Rust City to the suburban airport nearest to them have been discontinued -- just this week, in fact, and I didn't know until I searched on the airline web page and was offered itineraries that included e.g. eight hour stops in Pittsburgh and cost $2000. Of course I can fly to one of the main New York airports, but that'll be a huge pain, especially since I want to rent a car -- it's hard to see how I'd be useful as a visitor if I didn't, now that they've lost Ricky's free taxi access.

It is, of course, exceedingly unpleasant to contemplate the possibility of starting to miscarry on a plane. From what I've read on line it seems like I'm pretty unlikely to just start bleeding all over the place for a couple weeks yet -- if and when anyone offers me a D and C I'll take it -- but still.

Also, I don't think I should take Miss T. along -- but I don't want to leave her. She's had a horribly scattered couple of months, with the travel for the IVF cycle, and moving to a new room at day care, and Beaker having a couple of business trips, and now Mama being tired and sad, and the stress is showing. She really doesn't need for me to disappear for a couple of days.

So: I am risking not seeing Nana because I don't want to travel. There are several reasons,  all of which should be trumped by the possibility of her dying soon. Yet here I am this weekend in Ohindinois, grading away in my office.

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Directions from Cornell: "Keep taking the progesterone as long as there's a heartbeat." Well, that phrasing makes certain assumptions, doesn't it?

Schrödinger's Uterus

I have been wanting to tell people, this past week. I am tired of living inside myself, of walking around worrying about things only I know about, of holding back.

I have become very aware of how isolated I am on campus. This year's IVF adventures are at least partly responsible: I've been physically gone for all but the most minimal set of job-required activities, and I haven't been telling people why, and I've said so little that they can tell that I'm not telling them why.

My grandmother's health is a generally applicable cover story. But people notice when you don't tell them details. Hey! I told you all about my father's illness and death last year, how I struggled with choosing a home care aide and how long it took to settle the estate! And _I_ told you all about my divorce! Why aren't you telling me about your sorrow? Don't you trust me? (And it just makes it worse, I think, that there's a whole other category of sorrow that I haven't been telling them about at all.)

I have finally been happy, full of a good secret. I wanted to let it out and make other people happy too.

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The doctor located the heartbeat at least 3 times, but didn't say anything for a while. I could hear it, and see the pulses on the screen. That's too slow, I thought. Slower than mine, only like a beat per second.

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What are the odds at this point? I couldn't get a number out of him. I wanted to kill him. What he said in words translated to between 10 and 50 percent chance of miscarriage. His tone, his body language, the way he put a hand on my knee and said, "Don't tell anyone yet," read to me as 70 percent, or higher.

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At 7w1d, growth was normal, or nearly normal (6w5d), but the heartrate was only 67. The combination of normal growth and slow heartbeat seemed to throw the doctor off. "There's only one indicator. Usually we see more than one. Come back in a week and get a scan on the 3D machine. We'll be able to see structural abnormalities then. Sometimes there's a heart block and the rate can correct itself."

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Two questions:

1. This scan saw the remnants of a second implantation, like the first one did. But if there were two implantations, doesn't that mean my initial low progesterone reading (13 at 4w0d) is even more worrisome? (Today's doctor didn't know about that. Would it have changed his estimates?)

2. I've been bad and reading a due-date-club over at MDC. When it gets started this early, there are unavoidably going to be miscarriages. It seems that these often occur, in the non-infertile population, in something like the following way: someone goes in for a scan at 8 or 10 weeks, and learn that the fetus stopped developing at 6 weeks or so. If those women had gotten scans at 7 weeks, would they have seen what we saw today?

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The hospital has remodeled some of its lobby restrooms to "family" restrooms. I waited to use one on my way out. It was silent but locked for a long time.

Finally a short, middle-aged female doctor rushed out; her eyes held sideways, sniffling a long harrumphing sniffle as she went through the door. I went in and looked around the space. If I needed someplace quiet to cry, if I worked there and needed to hold it together the rest of the time, it'd be a fine place to go. Space. Locks. No one would know where you were.

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As I drove back to Granolaton, clouds gathered and it started to rain. Huge drops thwacking on the windshield, like the beginning of a thunderstorm. Ha! I thought. Exactly.

But then the clouds drifted away and, by the time I took the exit ramp into town, the sun streamed through their grey remnants.

Whatever.

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Today's doctor said to stay on the progesterone and come back in a week. I need to confirm that with Cornell, of course. But I made an appointment for another scan next Thursday.

Meanwhile I am pregnant. There is something in there growing. I am not crazy when I feel bloated or tired or nauseous or crampy or cranky. But what is growing is probably broken.

If you read infertility blogs (and if you read this one you must have been reading them for a long damn time!) you know that any bad news at all this early is honestly bad news. I know that too.

I'm not going to ask Dr. Google about this one. It was overwhelming back when when Miss T. measured 6w5d at 7w0d. I'm just going to wait for the next observation.

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Of course I was lying about not asking Dr. Google. And, as it turns out, Dr. Google has a strong opinion.

CONCLUSION: An embryonic heart rate of 90 beats per minute or less early in the first trimester carries a dismal prognosis, with a very high likelihood of fetal demise before the end of the first trimester. Demise occurred in all embryos with heart rates less than 70 beats per minute.

The good news and the bad news

The good news: the book is in!

Even better, there was no co-author-on-co-author violence in the final days, despite the sudden (brief! it came back up! oh my god!) collapse of our version control system.

The bad news: this grading thing. So I just started. Like, for the semester. This afternoon. They're way ahead of me: seven assignments in, and another coming tomorrow. Wheeeee!

Reanimation

My grandmother has tuberculosis. Not unheard of in the very elderly, although more common in immigrants. Generally it's a reactivation of a previous primary infection. Since, in cases like this, it was acquired, say, 50 years ago, it's not usually drug-resistant.

I asked my grandmother 3 years ago, when Miss T. was small, if she had nursed her three children. Yes for my mother, her first. No for the other two. The doctors had told her not to, since she tested positive for TB. That would have been in 1947 and 1952.

My uncle told me tonight that my grandmother had had a friend at high school (a tiny Catholic girls' school in the midwest) who died of TB. "She was just fifteen. She sat next to her in class every day! There were just twelve girls in the class, and the rest were pallbearers." That would have been in about 1930.
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My ultrasound yesterday went well. No heartbeat, but that's unsurprising at 5w6d. One gestational sac with fetal pole and yolk sac, placed high up in the uterus just like it should be. Perhaps the ghost of another, a quarter the size. "You might get a little spotting with that."
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I promised myself that I wouldn't even look at maternity clothing until after we see a heartbeat (it's sort worth worrying about: I have a midwestern winter of teaching coming up, versus the California sabbatical of last time). But then Garnet Hill sends me a catalog full of stuff like this and this. What are they thinking?

Sense of doom

My grandmother started coughing up blood last night. She's in the hospital now. She's had a bunch of scans. The staff are wearing masks around her, because "it might be TB." Ricky and Marina are both there with her today.

Ricky will be able to stay with her there tomorrow. See, he got fired from the taxi company. A second accident was enough to convince even the high school buddy who had taken him on (and kept him on for over seven years) that he wasn't worth the trouble. (The first accident? Somehow the accelerator hit the floor, as a six-year-old was trying to climb into the taxi. Marina told me about that one, and about how her painkillers were going missing, when I was last there. It was an unfortunate conjunction, as she was only too aware.)

This means that they're living off Marina's income. It also means that they have no transportation but buses and trains. Ricky asked the ambulance to take her to the hospital that's sort of on a bus line that goes by the apartment. Conveniently, Marina is working further down the same bus line. She'll be putting in an evening shift with Nana.

The detail that killed me? They've put a baby monitor into Nana's bedroom. That's how she got Ricky up when she started coughing.
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I re-checked Cornell's stats today. In my age group, 31.3 percent of cycles result in pregnancies; 20.6 percent in live births. What exactly do they mean by "pregnancy"? Gestational sac in the uterus, actually. So that's taking out the chemicals and the ectopics already. And I'm not yet past that threshold -- and just looking at that final number makes it seem like too much, like I cannot be that lucky, it is too damn low to allow hope, why did I do all of this again?
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Dr. Wow asked the publisher to extend our deadline by a week. It's a fucking good thing he's thousands of miles away from me. I am currently regenerating some very slow pictures and stewing.
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A ray of light? Radio Nigel. That's my 80's. (Ah, if only someone would stream WLIR's Screamers of the Week...)

5w0d and counting...

One week later, we're at 2239. A fine number, and entirely comparable to last time (this is a day earlier, again). Progesterone today? Unknown, but the the Saturday number had made it in and was "fine" at 31.

So that's it for bloodwork. Dr. D has changed his mind about early ultrasounds. Last time I had to wait until 7 weeks. Now he wants to check for ectopics, so I'm going in in six days and then again a week and a half later to look for a heartbeat.

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The bloom is off the new semester. Well -- it was never really on, I suppose, with the 2ww and all, and the book manuscript coming back from the copy editor and due on MONDAY FUCKING MONDAY OH MY GOD. 

So I haven't been doing a very good job of prepping, or grading, or being aware that my students exist as separate people with, like, names and opinions and needs and stuff.

For my upper level elective, it's been okay. I'm terribly lucky that it's huge and filled with enthusiastic students -- that makes everything so much easier.

But ergonomics-for-the-awkward? The class I have never been happy with, and neither have been its desperate distribution-requirement-fulfilling students? That I was supposed to redesign last summer, but then the book, the fucking book, and two goddamn cycles ate up all the time?

It could be worse -- and has been. But today I got e-mail from a student too, um, tired to come to class, and then e-mail from another that I'd offended in lecture, and -- and I don't want to get defensively depressed about it this early, really I don't, it's so unhealthy to do that, but it's going to be hard not to.

I'm really sort of obsessing about the second e-mail. If I'd been able to focus, really focus as I prepped, I don't think there would have been a problem.

I'm still maintaining faith that after the manuscript goes OUT THE FUCKING DOOR I'll be able to catch up. But so much of the quality of the interaction is determined by what happens at the outset, and I have let some of them down already.

Strangely consistent

So, last time, I had a doubling time of something crazy like 34 hours during the first week. I blamed it on switching labs between the two tests. Cornell claimed to be worried about multiples, which is sort of crazy; you change the initial conditions, but not the mechanism of increase, and Betabase shows (as you'd expect) that the doubling times aren't all that different.

I had blood run again this morning, 14dp3dt. God only knows when they'll get the progesterone number back (a week from Thursday?), but they managed to run the HCG in-house (like they're supposed to! today's phlebotomist didn't even believe me when I told her how they'd sent the last one out!), and it's up to 437. Which gives me a crazy-crazy-crazy doubling time of 28 hours and change.

I suppose that, technically, I did switch labs again... only 10 miles apart, not hundreds. Still.

And the number is...

... 72, at 11dp3dt, which is totally comparable to the 100 at 12dp3dt that we got before. (They like above 50.) Progesterone at 13 is a little low (they'd like 20), so I'm going to have to double my dose (ow!). Last time this worked I also doubled the dose at this stage, but that was because they never got a number back. The nurse first said come back for bloodwork in a week, then seemed to waffle about my going in earlier, maybe, because of the progesterone, so I volunteered for Saturday. Dr. D. used to do first ultrasound at 7 weeks, but now prefers 5 and a half; have scheduled something for 5w6d at local clinic, but am sort of seriously considering flying to NY...