by Emma Brockes
They don’t come up. The hormone, human chorionic gonadotropin, or HCG for short, is supposed to double every couple of days to indicate a developing embryo. Instead, it is steadily falling. I go on the Internet and type in “falling HCG numbers + still pregnant” and for ten minutes torture myself by reading posts from women with friends, or friends of friends, whose successful pregnancies defied the falling numbers.
It is hard for me now to revisit that moment, not because it was devastating, but because, in my memory at least, it wasn’t. It was a flat, sad experience that left me more baffled than crushed. I simply couldn’t make sense of it. A week earlier, I had confronted the possibility of never being able to conceive, and getting pregnant was clearly a reward for my suffering. That made sense to me. But a woman bleeds, gives up hope, gets pregnant, then turns out not to be pregnant at all? What kind of an ending is that?
Much later, a friend refers to this episode as “your miscarriage,” and that is the real moment of shock, not from any delayed reaction, but from the implication that losing a pregnancy falls into a single category of experience. Going in week after week is traumatic. Putting everything on hold for a pregnancy that might never happen is traumatic. This five-minute pregnancy, which is, at least, a respite from the monotony of another month of no news, is relatively bearable and to equate its loss with that of women mourning a baby whose ultrasound photo has been on her fridge for four months, or who has already felt its first kicks, just won’t do. To call this the loss of a baby is to sail very close to the right-to-life nonsense that anthropomorphizes a handful of cells. This is a disappointment, but it isn’t a miscarriage.
When I go in for the official verdict a few days later, Dr. B is cheerful. “It didn’t work out, but this is good news!” he says. “It means things are working, right? A met B.”
I suspect that turning on one’s fertility doctor is a stage of this process as conventional as standing up to one’s therapist and I refuse to be cheered by his cheer. Goddamnit, what was I thinking? Letting this man pump me so full of drugs that my nascent baby got washed away in the flood? Why did I ever trust him in the first place? It’s not as if I weren’t warned about ob-gyns. If every profession has a section that is known to be nuts—in journalism, obviously, it’s war correspondents, who can’t sleep without the sound of bombs dropping; in orchestras, it’s the brass section, specifically, the trumpet players (don’t EVER go out with a trumpet player, says my friend Kate, a professional viola player)—in medicine, contrary to the layman’s assumption that it’s the surgeons who are crazy, those godlike creatures who get their kicks from plunging their hands into other people’s entrails, doctor friends say this is not in fact true. The maddest, baddest, most lunatic doctors—the ones you should never under any circumstances date—are the ob-gyns. It makes sense, if you think about it. Surgeons only save lives; obstetricians and reproductive endocrinologists can reasonably lay claim to creating it.
In this light, Dr. B doesn’t look like my sane, affable, pragmatic ally, a man doing his best to get a result without bankrupting me, but a towering megalomaniac for whom no risk is too great. As he draws up a drug schedule for the forthcoming month’s treatment, I snap, “I want to take fewer this time.” I have no medical authority on which to base this request, but it seems to me intuitively right to assume that I lost all that blood and ultimately the pregnancy as a result of taking too many drugs. Dr. B raises his eyebrows and delivers a speech about fertility treatment being a blunt instrument, an exercise in risk and reward.
“Still,” I say.
“I understand.” But he gives me an exasperated look as if to say, “Do you want this to work or don’t you?”
I do. I want it to work. But I have also, suddenly, had enough. The relief of having been pregnant, even for a day, brings on a motivational collapse the way that going on vacation after working too hard often unleashes the floodgates to illness. I’ve had enough of eight a.m. appointments and blood tests and ultrasounds; of tiptoeing around my own body as if it might explode in my face. I’m sick of banter with the nurses and game face with the doctor and of handing over my credit card after each visit, for the ultimate addition of insult to injury. I’ve had enough of pluckily pretending it’s all going fine. I need a break.
“Take a month off,” says Dr. B, genially. “Give yourself time to recover.” The following weekend, a friend is having a birthday party in London and I decide then and there I will go.
“Perfect,” he says and suggests I take my prescription with me; I can buy the fertility drugs more cheaply in England. I try to imagine handing over a prescription written by a New York doctor to the pharmacist in my dad’s Chiswick branch of Boots and burst out laughing.
“They’ll honor it,” says Dr. B.
“They absolutely won’t,” I say, adding stiffly, “That’s not how the NHS works.” I think of the universal £8.05 proscription charge for all drugs in England and feel a surge of love for the motherland.
“Well, then,” says Dr. B. He lowers his voice. “There are various Web sites. . . . It’s called the gray market.”
I haven’t encountered this before: the shipping of drugs across state and country lines to exploit regional price differences. That afternoon, I go online and find small pharmacies in, for example, Scottsdale, Arizona, or San Antonio, Texas, undercutting New York suppliers by several hundred dollars, and that’s before I look into Canada or Mexico. In each case, these Web sites inform me, I am required to scan my prescription and, with what feels like a big wink, e-mail it to the pharmacist before the drugs will be released. It’s not a safeguard I can see the New York State Board of Pharmacy being impressed with if something goes wrong and I turn to them for redress. On the other hand, the drugs are up to a third cheaper. For an hour, I click on banner sales ads promising the “cheapest fertility drugs on the Internet” and try to convince myself that just because the phrase “savings of up to 40% on fertility medication bundles!” makes the pharmacy sound like a cash-for-gold pawnbroker, doesn’t automatically mean it’ll kill me. If there is one thing this experience has taught me, it is not to confuse my distaste for the sales pitch with distaste for the service being sold.
“Hmmm,” says L. “I wouldn’t.” She is making the baby dinner in her kitchen. I am leaning against the counter, looking out across the Upper West Side toward Central Park and beyond. It’s a view from a postcard, a skyline that will always be thrilling to someone from a low-rise city like London and that makes me wonder why I’m ever nostalgic for home.
“Did you tell him you want to take fewer drugs this month?” says L.
“Yes.”
“But you have to really tell him.”
“I did.”
“No, you didn’t.”
“I DID.”
L is as taken aback as I am that things aren’t going smoothly, not because she’s an optimist—quite the opposite; she tends toward alarmism—but because my role, generally, is to breeze along being untouched by things while hers is to see the potential for disaster in everything. Unlike me, L has no social qualms about being seen to be difficult, and not in the performative sense. There’s a type of professional New Yorker who sends food back in restaurants and yells at cab drivers and won’t go to Brooklyn because it’s “too far” and hates the countryside on principle, and this person, inevitably, comes from Florida and moved to New York at the age of twenty-four. L, who really is from New York, sends back food and is always yelling at cab drivers, and hates Brooklyn, and will tell a doctor of thirty years’ standing that he’s going about things all wrong, but she doesn’t think she is being cute while doing any of this. She doesn’t think she is being anything. She is simply being, without repression or filter, and I can only look on from the sidelines in wonder.
“It’s only been, what, four months?” she says. “You’re panicking too early.”
“Maybe I should just move u
p to IVF?”
“I don’t think you need to. I think they messed up this month and next month will be better. But you have to be in control.”
I infer criticism in this remark and bridle. The thing is, I don’t really want to be in control, not over things I know nothing about. I don’t want to be more active in dictating my treatment schedule based on—good god—intuition and an hour’s research on the Internet. On reflection, I also don’t want to buy cut-price drugs from Arizona. There are some things in life one knows not to buy cheap, eye surgery and sushi being the most obvious two, and to that list I now add fertility drugs. Even if the pharmacies don’t try to palm off dodgy or out-of-date drugs on their mail-order customers, the way online groceries do with stale bread, the thought of injecting a substance into my body that has come via mail order—that has, over the course of its shipment, been handled by a chain of couriers, some of whom potentially work for Delta—makes my veins freeze in terror. I’d rather pay the full whack and have someone local to sue if I end up cooking my ovaries.
What I do know, with what feels like a mathematical certainty, is that the emotional cost of trying to get pregnant has to be balanced out with an input of joy. At the end of the week, I fly to London. For once the low English sky doesn’t depress me but feels comforting, like a mottled old duvet thrown over my head, and when I walk into my friend’s party on Saturday night, it is to faces I have known for twenty years.
“Are you all right, my little love?” says Merope, in a tone that, after almost two decades of friendship, instinctively avoids my dislike of certain forms of sympathy and makes her one of the few people to whom I would ever reply no.
“I am.”
And for the space of the evening, I am. The party is in a garden, under a tent, where there are fairy lights strung across the canopy and a dance floor laid out on the lawn. I get giddy on cocktails and tell a friend of a friend, a woman I like but don’t know well, how crazy my last month has been and she tells me her own fertility history, how, to her immense surprise, she conceived spontaneously with her husband in her midforties and how lucky that was.
“You’ll be lucky, too,” she says.
“It’s a slog.”
She smiles. “But it’s so interesting.”
From this vantage point, my life in New York looks unreal, a small, bright pinpoint on the horizon that disappears the minute I leave. London is the reality and New York is the dream. Even my failure to get pregnant dwindles to an abstraction—oh, that—and for the space of an evening I shove it off to one side. I know this impression is misleading, and that if I acted on it and moved back to London, the novelty of being home would wear off in five minutes and I’d be whining, once again, about my life having dwindled to a tiny set of known variables. But for one night, it is glorious. There are champagne and speeches and dancing. More old friends arrive and there are ecstatic hellos followed, hours later, by sloppy good-byes. Someone topples backward into a hedge. “Is she all right to drive?” “Oh, I expect it’ll be fine.” At the end of the night, there is the quintessential London experience: waiting for a minicab in a persistent light rain in clothes slightly too thin for the weather.
The next morning, my dad drives me to Heathrow. It has been a short visit, so he parks and comes into the terminal.
“This all sounds a bit brutal,” he says, over coffee and bacon sandwiches.
“It is a bit.” There is a long pause.
“Don’t overdo it.”
We don’t say any more than this. My dad pays the bill and walks me to the security line. “KBO,” he says, giving me a hug. “Keep buggering on.” There are times when I really do love being English.
* * *
• • •
IT IS DIFFERENT this time.
“How do you feel?” says Dr. B.
“I feel messed with.”
For five days, I have been injecting myself with a preloaded injector pen—same hormones, different delivery system—which, either because I’ve become cavalier with the needle or because something in the technology has failed, has bruised me terribly. The skin of my abdomen looks like seventies wallpaper, all bright purple flowers with a greeny-blue border. I feel altered, inert, hideously bad tempered.
“I can’t sit on the subway for an entire hour to come and see you,” I say to L on the phone after work.
“OK.”
“It’s a whole hour.”
“OK.”
“A WHOLE HOUR.”
“OK!”
I tell myself it’s chemical and will pass, like PMS or the low spirits brought on by a hangover. But it doesn’t. “We don’t know what these drugs are doing to us, in the long term,” says a friend one day in a studio in Chelsea. She is coordinating a photo shoot with a supermodel I’m due to interview afterward. It’s a job I might have turned down, if I didn’t have one eye on the fertility meter and another two-thousand-dollar bill for drugs this month. I hadn’t known about my friend’s history of IVF. This is what happens when you have fertility treatment; it’s is like being the victim of a crime or getting a dog—suddenly everyone’s a dog person or has a granny who was recently mugged. In this case, my friend’s failure to conceive after two cycles left her with a negative view of the whole industry. Long before exhausting her treatment options, she had the strength of mind to pull the plug and eventually she and her wife adopted. She urges me to consider doing the same and although I make conciliatory noises, I know I won’t do it, not yet. The threat of future ill health is too vague compared with the immediate threat of not having a baby. Will injecting fertility drugs turn out to have been unwise? Maybe. Would I trade in the possibility of having children to eliminate that risk? No. Every day, bigger risks are taken for much smaller rewards. After all, people still smoke.
A week after finishing the injections, I return to the clinic, where there are bowls of salad and trays of baked ziti laid out in reception. “Help yourself,” says the receptionist and explains they have been sent over as a gift by a drug company. Next to the food, a sign has gone up advising patients that the clinic is being considered for a reality TV show and anyone interested should make themselves known.
“What’s this?” I say. The receptionist shrugs.
“Really?” I say to Dr. B when I enter his office. “A reality TV show?”
He raises his eyebrows. “What?”
“Bit intrusive, maybe.”
He makes a dismissive sound. “Do you think those people on Jersey Shore regret doing it? They’re all millionaires now.” He looks at my charts, tells me to stop taking the drugs and ten days later I go in for the insemination. Number five.
“Whoa,” says the nurse doing the preliminary ultrasound. “You have a lot going on in there.”
I look at the screen; a lot of shapeless dark patches connected by strings.
“They look like spider’s eggs,” I say and shudder.
I have, once again, overreacted to the hormones. But Dr. B says not to worry; not all of them are mature. He makes a halfhearted gesture to indicate that, of course, if I want to be a purist I can call off the cycle and once again I say go ahead. He is in a good mood that day and after the insemination pulls up a chair. “What’s been going, what’s the news, what’s happening in the world?”
“Beyoncé.”
“Oh, yes, the nurses have been talking about that all week.” Beyoncé’s sister and JAY-Z had been involved in a fracas in an elevator, footage of which had been leaked to TMZ.
“What else?”
“Jill Abramson’s been fired from the Times.” I am curious to see what Dr. B does with this; his response to current events isn’t always predictable. I once referred, in passing, to a famous female media tycoon, eliciting the rather surprising remark “She’s a pure opportunist—the kind of person who’d have conspired with the Nazis. You know?”
Dr. B
takes the news about Abramson and runs with it in the direction that the New York Times is an establishment stooge propping up the corrupt economic order. Something about quantitative easing and how we should have a gold currency. I get in a remark about pay disparity between men and women, which makes the young nurse at the desk look up sharply.
“Dr. B?” Another nurse puts her head around the door. We have chatted pleasantly for twenty minutes, the atmosphere as unstressful as the previous month’s had been harried. Feeling grateful to the doctor, I get up to leave.
“How many eggs were there?” L asks, over dinner that night.
“Fewer than last time.”
“What, four?”
“Something like that.”
“Not more than four?”
“I don’t think so.”
She looks at me suspiciously. “Because if it was more than four you should’ve told him to cancel. Remember what happened last time.”
“It wasn’t. It was around four.”
The weekend is lovely. The sun comes out and L and I take a walk along the Hudson with the baby in the stroller. I feel Zen in the face of all possible outcomes. On Monday night, I go into my kitchen and crack an egg against the side of a saucepan for dinner. Two bright yellow yolks slide down into the pan. I have never seen such a thing before and, standing at the stove, stare down at the eggs feeling bad for the hen. I am so surprised I say it out loud: “Twins.”
* * *
• • •
I KNOW WHAT L is thinking: that if I go ahead with the insemination with more than a handful of eggs, I am risking not only my own welfare but hers, too. We are supposed to have one child apiece, that’s the plan, a Venn diagram of two independent families, each with its own space and autonomy but that overlap in the middle for support. Two things threaten this vision: if I fail to get pregnant, or if I get pregnant with more than one baby. I can see her point; it would upset the whole balance of things. It would use me up, seal me into my own experience, make it much harder for our lives to converge. And while it would crucify me emotionally, financially, physically, even socially, it would also, obscurely, mean I had “won.” This is very, very bad but every time I think of having more than one baby, my horror is mitigated by an imaginary air punch, the female equivalent of a testosterone high.