An Excellent Choice

by Emma Brockes

  So, out I go and audition some doctors.

  FOUR

  Tubes

  MY DAD IS NOT GIVEN to excessive displays of emotion. He is calm, reassuring, extremely measured about all things. Before he retired, he worked for forty years as a solicitor specializing in conveyancing, the least theatrical corner of the legal profession. The only subjects on which I have ever heard him voice an intemperate opinion are the filthy hot dog vans in central London, which he would like to firebomb, and Boris Johnson (“a toe rag”). Before leaving London, I do the one thing guaranteed to make my plan real; I mention it to him. Once you involve a parent, you open up a channel of concern and inquiry, a drip drip drip that it will be almost impossible to divert or fob off. It’s like promising a toddler a treat; change your mind and you’d better have your story straight.

  “So the plan is,” I say, “that next year, or something like that, I’ll do what L has done and try to get pregnant, because I’ll be turning thirty-nine, time to crack on, makes sense if I want to have children, which I do, always have in fact, actually. Yup. So. That’s.”

  We are on the road to Heathrow, driving around the southwest corner of Turnham Green just before Chiswick Town Hall. “Hmmm,” says my dad, looking straight ahead.

  I glance at him sideways. My dad is in favor of L because I am in favor of L, and also because he likes her. Along with Marion, my dad’s partner, he has been enthusiastic about her baby. On the other hand, throwing a second baby into the mix without putting the relationship on a more formal footing is a challenging bit of news to absorb. My dad is liberal, but he is also a sixty-nine-year-old man who was married to my mum for thirty years. I wonder if even for him this mightn’t be a step too far.

  Nothing more is said about the baby that day, something that might worry me if I didn’t know him so well. My dad has a habit of going quiet at the time of a major revelation, then chiming in later when he has had time to think. I know he’ll be concerned about the logistics, not only of how I might cope alone with a baby, but of how I might cope alone with a baby so far from home. He’ll wonder what my mother would have said and how she would have wanted him to respond. I smile as I consider this. The big gap in my mother’s liberalism was around the raising of children; she was against people having kids outside of marriage. She thought pedophiles should be put to death or castrated. I don’t recall us ever talking about gays having children—it wasn’t around much as an issue in 1980s Buckinghamshire—but in spite of the fact that most of her best friends were gay men, my sense is she would have been disapproving. (In this she would, I think, have made a distinction between the suitability as parents of two men and two women.) For all her eccentricities, my mother idealized or even fetishized the traditional nuclear family, which she saw as a safeguard against the kind of childhood she suffered. On the other hand, she also saw it as her greatest achievement that I was free from that baggage and I have a feeling that, if I’d come to her with my plans that fall, she would have decided there and then that having a child alone, or in the context of an unconventional relationship, was the most brilliant thing any woman had done in world history. A few days after I get back to New York, my dad calls me at my desk in Brooklyn. “I’ve discussed it with Marion and we’ll support you in whatever you do,” he says.

  * * *

  • • •

  CHOOSING A FERTILITY doctor is not like choosing a knee surgeon. If it was, you might simply browse a dozen clinic Web sites and pick the one with the highest success rate. Instead, when you meet a fertility doctor for the first time, you find yourself making all sorts of unscientific judgments. Do I like you? Do I approve of you? Do I want you to play a role in the story I tell about my kid’s creation? Are we on the same wavelength so that my body doesn’t go into spasms of dislike whenever it sees you and resists the tasks it is being asked to perform? All nonsense of course, otherwise no children would be conceived in bad relationships, but there you are. The dreadful woo-woo bullshit around fertility begins here.

  “So how can I help you?” says the doctor. She is the first on my list, an ob-gyn with an office in Midtown who has come to me recommended by friends. I sit before her, legs crossed at the ankle, feeling like I’m on a first date and trying to revive my spirits after the experience of the waiting room, a tiny windowless space with an ornamental fountain that tinkled away like something designed to soothe the unnerved. The only other woman present was in an iron-gray suit and had very tightly curled hair. It described the atmosphere perfectly.

  The doctor is in her late thirties, with big, sad eyes and an air of almost lascivious sympathy. Not my kind of doctor at all. In New York, my favorite doctor is Dr. Dolphin, my eye guy, who, sliding a needle into my lower lid one time, said, “Who’s having more fun than you right now?! OK, heel to the steel!” (In the UK, my favorite doctor is the bluff, middle-aged woman GP who told me I did not, in fact, have stomach cancer, but had for years been wearing my jeans too tight.) This woman looks as if she were about to cry, and to overcome her piety, I crank my jocularity so high I sound like a seventies game show host. “Want to have a baby! . . . About to turn thirty-eight! . . . In a relationship but taking full moral and financial responsibility!”

  She nods, unfazed by any of this, and after asking me a few general questions suggests we adjourn to the treatment room next door for the ultrasound. “Out of interest,” I ask, gathering my things, “how old is the oldest client on your books?”

  “Forty-seven,” she says and adds quietly, “It’s too old.” I am so surprised by this candor that I feel myself warm to her, before realizing what I’m actually experiencing is a mean-spirited high from not being considered the worst-case scenario.

  No one has ever looked at my ovaries before. No one has ever looked at my kidneys before, either, but kidneys are different, and as I climb onto the gurney, I find myself worrying about them on the basis that women worry about every other part of their anatomies: not that the doctor will discover something medically amiss, but that she’ll hit upon some hitherto unrevealed ugliness. They could be misshapen, or asymmetrical or in the wrong place. They could be completely vacant, like one of those trick gift boxes that are empty save for a Christmas cracker–style joke. Perhaps all these years I’ve been sailing along thinking myself anatomically normal when, all the time, some twisted anomaly has been lurking within.

  “Here,” she says neutrally, and points to several dark patches. “Fibroids.”

  “OK.”

  She skims around a bit more, seeing things I can’t see, then abruptly switches off the machine. “Very common, nothing to worry about, although we would keep an eye on them for growth.”

  This is the first and most superficial of a battery of tests that need to be done before treatment can start. My ovaries may look OK on the screen, but it remains to be seen if they’re actually working, and to move on, says the doctor, there are more preliminaries—not, as in England, discussions about my emotions or lifestyle, but concerning something much more important: money. That is the real precursor to receiving medical treatment in the United States, and after the ultrasound, she ushers me through the waiting room into the office, for a meeting with someone far more significant than she is—the clinic manager—to talk about fee structure and financing.

  Insurance anxiety is such a big part of this story it is worth pausing here to describe the lay of the land. My policy, which is administered in England and is available only to British nationals living abroad, is, with one very large caveat, absurdly generous by American standards. For the same price as the most punitive and exemption-ridden American policy, I have no deductibles, a co-pay of forty dollars per visit and, as far as I can tell from glancing at the small print, more or less limitless disbursements, so that in the years since moving to the United States, I have hammered it so mercilessly—endless checkups (it doesn’t cover checkups, but every doctor I’ve been to has supplied the fake codes); m
ultiple trips to Dr. Dolphin for recurring blocked tear ducts; an expensive biopsy on a lump of gristle in my right breast that a British doctor had deemed, on the basis of a manual exam, entirely harmless and that of course after thousands of dollars’ worth of exploratory tests in New York, turned out to be so—that my dad jokes about selling his shares before I bankrupt the company.

  A few days before my trip to the doctor, I had called my insurer’s hotline in England, to see if they would cover my treatment.

  “So, your husband—” said the operator. There was a pause, during which I could hear her belatedly engaging with the requirements of EU discrimination law. “In order to qualify for fertility treatment, your partner must also be a policy holder of at least two years’ standing.” Damn. Gender-neutral language. I had been all ready to bring up L and frighten them into approving me.

  “What if there isn’t one?” I said.

  “I’m sorry?”

  “What if I’m having a baby alone?”

  “I . . .”

  Static over the Atlantic. I felt sorry for her then; she was probably twenty-four years old and sitting in a cubicle in a business park in Slough.

  “That wouldn’t be covered by the terms of your policy,” she said eventually.

  “Can I ask why not?”

  “I . . . it . . . I would have to . . .”

  I could fight this. But the truth is, I don’t really see why my insurers should pay for it. I understand that if the policy covers one type of person for treatment but not another, judgments are being made about who is deserving. And if they were denying me coverage on the basis of my sexuality, I would make all the necessary complaints. But either through moral cowardice or preemptive exhaustion at the thought of waging a futile battle, I have a tough time seeing “single woman” as a category that, in this instance, deserves equal protection under law. After all—and I have never articulated this to myself quite as clearly as I do in that moment—it isn’t very respectable. It’s selfish. I’m selfish. No more selfish than anyone else wanting a baby, but to make a lifestyle choice that deviates so spectacularly from the norm and then expect other people to pay for it seems to me to be a bit bloody much. I get off the phone with a breezy “no problem,” as if my inquiry had been entirely hypothetical, and think, maybe it’s better this way. If it is going to be hard, let it be hard from the outset so I have time to muscle up and adjust. Insurance be damned, I’ll pay for it myself.

  The truth is I’m not yet worried about the cost of all this. I’m almost forty. I have a lot of savings. I’ve never spent more than I earn. I own property in one of the most valuable markets in the world. I think of all this, rather vainly, as being “sensible about money,” although it has more to do with having (in English terms) a middle-class background, with all the safety nets and security that brings. A lot of outlandish things would have to happen—having more than one baby, say, or the economics of the entire news media falling into a hole or Britain’s deciding to leave the EU, wiping a third of the value off sterling, none of which, obviously, is going to happen—before my assets start to dwindle. Looking ahead, I even relish the prospect of a little financial pain; it will reboot my ambition, I think, make me hungry again, less sour about interviewing actors. Besides, how expensive can one tiny baby be?

  The worst I can see, out of the corner of one eye, is the terrifying cost of IVF, which seems to go up in increments of fifteen thousand dollars and which, above the age of about forty-two, I once heard described by a doctor as “throwing money into a pit.” At thirty-seven, however—which, in what might be the single attractive thing about the fertility industry, I’m learning can be stated as “only thirty-seven”—there is nothing to suggest I need IVF. What I need is IUI, intrauterine insemination, a medicalized version of the turkey baster in which the sperm is launched, via catheter, high up into the womb, minimizing the distance it has to travel to meet the egg. It’s cheaper than IVF and much less invasive, requiring in the first instance neither injections nor general anesthetic. That is the good news. The bad news is that for IUI, the broad-stroke success rate for women my age is roughly 12 percent per cycle.

  I know this only by accident. One of the things I can never figure out is how, in the face of big life choices, one draws the line between finding out enough to make an informed decision and finding out so much you can’t make a decision at all. My approach, so far—except on those occasions when I have failed to shut down a Web site quickly enough—has been denial. From the outset, I decided the only way to proceed without becoming paralyzed by fear was to limit my thinking to a tiny, immediate-term time frame. It’s like the thing E. L. Doctorow said in every interview he gave, including to me; that writing a novel was like driving a car down a dark road at night—he couldn’t see beyond the arc of the headlights, nonetheless they guided him home. I won’t think about money yet, or living arrangements or relationship status. I won’t think about the fact I don’t have a green card or that my dad lives three thousand miles away. All I need to get home is hope and a measure of ignorance.

  The clinic director doesn’t mention the 12 percent success rate. To listen to her, you would think no woman over thirty-five has ever had trouble conceiving, and as she talks, I become aware that for my own denial to be sustainable, I must be sure that everyone else in the chain is operating fully in accordance with reality. Patient denial is an act of psychological defense; doctor denial is scalping.

  “Here,” says the director and hands me a glossy brochure advertising the clinic’s special deal—three rounds of IUI for the cost of two, not including drugs, blood tests or unforeseen complications. It’s five thousand dollars for the package and if I want, she says, I can pay in installments.

  “OK?” she says.

  This is not a good moment vis-à-vis my newfound enthusiasm for American health care, but I meekly reply, “Yes.” Then I go home and freak out.

  How on earth can one buy medical treatment the same way one buys three-for-two cans of beans at Costco? What if, after the second round of IUI, the prognosis looks so grim that any sensible doctor—that is, one not bound by a bulk sales agreement—would recommend a move to IVF? What if I get pregnant on the first round? Doesn’t this approach guarantee that, at some level, the doctor’s decisions will be based on commercial, not clinical, considerations? If a clinic thinks bulk sales are a good idea, mightn’t they think ordering tests I don’t need or performing unnecessary procedures are equally good ways to make money?

  It reminds me of those dentists who try to push Botox on you while they’re flossing your teeth and, sure enough, a day or two later, the hard sell continues with an e-mail not from the doctor but from the clinic manager asking me to “review the financial portion” of my visit and repeating the benefits of buying a “multiple package.” Also, she says, because I intend to use donor sperm, I should be aware that the clinic charges three further fees: a $200 handling fee “for all cryopreserved materials,” a $100 fee for “thawing the sperm” and a $500 storage fee, should I wish the clinic to hang on to any unused sperm. I send back a polite note saying I have a lot to think about and will be in touch at some point in the future. Two years later, I’m still receiving their newsletter.

  * * *

  • • •

  “AMAZING,” SAYS OLIVER. We are at a French bistro on the corner of Smith Street and Degraw, which is roughly halfway between his apartment and mine. (It’s nearer mine, by a whisker. Whenever we have lunch, which we do most weeks, one or other of us checks Google Maps to determine who has the longer walk to the restaurant. Today I have won by about seventy yards.) “What are you going to do?” he says.

  “I don’t know. I suppose keep looking for a doctor.”

  It is funny to be here having lunch as we always have, with this discussion about kids on the table. Our lives have both changed since we came to New York—Oliver has written a book and has an American girlf
riend; my life is full of L and her baby; we have both acclimated to working at home after ten years in an office—but in some ways, nothing has changed. In spite of a certain surface cynicism, I think we are both still romantic about the country we moved to. Some of my notions about the United States were dispelled within the first few weeks of arriving, but the one that has stubbornly failed to die is that, with the exception of banking technology, America is a place where the future happens first. You can do anything in America. You can change who you are, or at least what you look like, so that seven years after moving, although I am still, at heart, a disheveled English person, I sit across the table from Oliver today with a better haircut, a bigger wardrobe and, after a lot of badgering from L and to the disgust of British friends, shiny white veneers on my teeth. (From a patriotic standpoint, cosmetic dentistry is to British people what burning the flag is to Americans.)

  Oliver sits, as he always does, in a dark sweater with a zip up the front, buffer than he was when we lived in Britain and, I notice, with the first gray flecks at his temples. Like many thirtysomething men, he is somewhat mystified by my certainty that I want to have a baby, and can cite a handful of studies testifying to the fact that parents are slightly less happy than people without children.

  “A study says . . .” I say, teasingly.

  “But I’m genuinely curious. How do you know?”

  “I just do. I just know that it’s right for me.”