Adventures in Fertility and Mortality
By Zahie El Kouri
“Do you believe in an afterlife?” the doctor asks.
I’m lying on an examination table, wearing a sweater and socks, my feet in stirrups. A nurse has given me a folded, translucent square of paper, and I choose to leave it folded to cover my lap effectively rather than unfold it to cover more of my body while leaving nothing to the imagination. The doctor slides a special probe up what the truly educated are now calling the vajayjay. I am about to start my second round of in vitro fertilization, and the doctor is doing a baseline transvaginal ultrasound to see if we can go forward.
For some women, this kind of ultrasound is no big deal, but for me it is so uncomfortable it verges on the painful. I know I’ll be less uncomfortable if I relax, but I can’t do that because the doctor and I are talking about my father’s death.
My husband, John, is sitting by my side, and he squeezes my hand when he hears the doctor’s question. John is sad about my father’s death, sad that I have to go through all this medicalized stripping down, sad that sex has been taken out of our procreative equation. But he is also tired of being sad. That’s why minutes ago, before the doctor arrived, when I was crying while taking off my clothes, he tried to distract me by singing the tune of what he says is the music one finds in porn. Bam ba dah bam bah. Humor is the way he copes with stress and sadness, and the doctor has undone the moment of laughter John and I shared in his absence.
“So, how long has it been since your father died?” the doctor asks. He is looking from my vagina to the monitor and back again, and pushing buttons on a side panel. His glasses are smudged, and through a trick of the light, I can see my reflection in them, even though he isn’t looking at me.
“About six months,” I say, even though I know the answer down to the day.
“Was it a long illness?”
“No, just ten weeks. Pancreatic cancer.”
* * *
In many ways I’m a typical fertility patient, if there is such a thing. I am thirty-six years old. I have been trying to get pregnant for three years. Seven months earlier I lost my first pregnancy, achieved through IVF, to miscarriage. Two weeks before this appointment, I started injecting myself with Lupron, which has put me into temporary chemical menopause, a condition that, ironically, will help me get pregnant through IVF, even though the associated mood swings and headache may also alienate everyone who has ever loved me.
Fertility and mortality are not the only things on my mind. Just a few months after my father’s death, John and I moved to this new city for his new job. My mother is staying with us because she is too sad to be alone, and my in-laws are visiting, and all the parental attention only highlights my father’s absence.
In many ways, I am alone in my grief, and in my mind having a baby has become all tied up with my father’s death. A grandchild was perhaps the thing he wanted most in life, and I feel like a failure for not finding the right person to marry earlier, for not having a baby before his death. I can blame the weepiness and the irritability on the chemical menopause (and I do), but I know that I am sad and desperate because I am still trying to redeem myself.
I want a baby—I have always wanted a baby—but the truth is that, without my father’s death, I might have chosen not to do all of this. I might have chosen adoption. The truth is that, yes, I do believe in an afterlife, in a religious sense, but that belief does not save me from my grief. It does not keep me from missing my father. The truth is that I am loath to start injecting myself with drugs that will hyperstimulate my ovaries. I am loath to go from chemical menopause to chemical super-fertility in ten seconds flat. But the most important truth is that right now, I am willing to do anything to preserve my father’s genetic legacy—other than my memories, the only piece of him I have left.
“Well, do you believe in an afterlife?” the doctor asks.
There is a long pause, and eventually, John answers the question for me.
“Yes,” he says. He takes my hand and squeezes it. “She does. Her priest really helped us through it.” John leans toward agnostic, but he, too, is transformed through this experience of death. He prefers humor, but he knows when to step in and be serious.
I cannot look at John without crying, and I don’t want to answer the doctor’s question, so instead, I spend my time coming up with all the possible reasons for the doctor to ask me this question at this particular moment. I come up with three:
1. The doctor may think that making any conversation will distract me from what is going on with my body, and therefore relax me (like a Caribbean vacation with no hurricanes).
2. The doctor is particularly curious about my unique presentation of the human condition. The doctor has lost a loved one, and has found solace in his belief in an afterlife.
3. The doctor is bored because he has seen too many vaginas.
I begin by considering reason #1. Maybe the doctor has had success with making small talk while doing transvaginal ultrasounds. Maybe, after dealing with thousands of women desperate for a child, he believes that having a conversation about something other than fertility will relax me, reduce stress, and increase my chances of getting pregnant. Maybe he sees himself as part therapist, and knows that I am in desperate need of some therapy before I should be allowed to get pregnant.
This may all be true, but I still rule out rule out reason #1, as it is unlikely that anyone would think that asking about a patient’s father’s illness and death would distract her from a penis-sized plastic probe up her vajajay.
I next consider reason #2. I vaguely remember this doctor mentioning losing his own parents. Maybe he struggles, as a man of science, with issues of faith and mortality. Maybe creating fertility miracles every day has given him the intellectual space to consider the possibility of an afterlife. Or maybe it is the opposite. Maybe he doesn’t believe in an afterlife, but he envies those who do?
If I were being rational, I might conclude that I can explain the doctor’s behavior with reason #1 or reason #2. He is a warm and friendly man. Like my husband, he’s sad for me. But I don’t want to dwell on these possibilities because they are just too painful, so I go with reason #3—the doctor has simply seen too many vaginas.
Now, to be clear, my doctor is a board-certified reproductive endocrinologist with an excellent record of successful IVF pregnancies, so he sees more vaginas than say, your average neurosurgeon. He probably also sees more vaginas than your average obstetrician/gynecologist, as your typical patient comes in once a year, takes off her panties, and that’s it. She might get pregnant, in which case, she would be coming in every now and then for exams, and then there would be the labor, where the doctor would see a whole lot of her vagina, but still, most women don’t go through labor more than once a year. Unless they have multiple uteruses, but that might present other issues that might also require a specialist.
It’s not that I think my vagina is anything special, or that I don’t appreciate the square of paper or the fact that my doctor will spend the extra ten minutes talking to me about my IVF cycle or inquiring as to my state of mind and grieving process. I respect the Swedish position on nudity and the time-honored tradition of skinny-dipping. It’s just that I miss the days when the only naked conversations I had about the afterlife were with my husband. I am tired of being physically and emotionally exposed. I don’t know how to talk about my feelings about death while trying to create new life.
* * *
In the next year and a half, I manage to get pregnant and miscarry twice more. I travel to another state for even more specialized medical treatment, coming back to the afterlife doctor for early-pregnancy monitoring when I get pregnant for the fourth time. In the appointments, he is still friendly, though he discusses work with John instead of discussing death with me. When I’m eight weeks pregnant, he sends me on to an obstetrician, wishing me the best.
That pregnancy took, and I gave birth to a healthy baby boy in June of that year. Soon after, I see this doctor again, as John and I leave the office of a lactation consultant who shares his waiting room. The doctor’s receptionist sees us walking by and sends him out to see us while we’re trying to get our crying baby into his car seat. The doctor approaches and greets us with a smile. After asking permission, he takes the baby and dances around with him. The baby stops crying and looks at his reflection in the doctor’s smudged glasses.
“How are you feeling?” he asks.
“I’m great,” I say. “Tired, but happy.”
“That’s good to hear,” he says. “Isn’t that good to hear?” he asks the baby in a sing-song voice.
John and I smile at each other.
“Who do you think he looks like?” the doctor asks, looking from the baby to my husband, and back to me. “I see bits of both of you.”
“He looks like Zahie’s father,” John says. I have never heard him say this before. “It’s nice.”
I stare at the baby with new eyes. I have been so sleep-deprived since his birth, so focused on the work of keeping him fed and clean and making sure he is still breathing, I haven’t really studied his features.
John is right—there are my father’s big brown eyes, his full lips, his round face. I hope to see my father in the afterlife, but I am happy to have these pieces of him here with me now.
* * *
Author’s Note: “Once infertile, always infertile.” That’s what my friend used to tell me when she was pregnant and I was still in the midst of my infertility struggle. At the time, I thought she was a little crazy, a little whacked out on pregnancy hormones, but now I know what she means. My ongoing mental state of infertility, which persists despite the presence of my vocal, playful baby, leads me to check the infertility message boards every day, and to pay special attention to any personal essays about infertility or fertility treatments. I’ve noticed a trend lately of comments on these essays saying that women who go through IVF to get a child instead of adopting are selfish. Was my desire to see my parents in my child selfish? I think about this question all the time. I wish more peace in this question for others, and I hope that this essay will give a sense of some of the emotions connected with wanting a child with a genetic link to you—and the ways in which those emotions are so much more complicated than the word selfish might ever contain.
Brain, Child (Spring 2012)
Zahie El Kouri writes about family, fertility, and immigrant culture. As the child of a Syrian/Lebanese/Palestinian father and an Italian mother, she has a special interest in the experience of second-generation immigrants, within the family and without. Her creative non-fiction has appeared in Memoir Journal, Brain, Child, Garbanzo Literary Journal, and Ars Medica. Her short fiction has appeared in Mizna, a Journal of Arab American Writing and the second edition of Dinarzad’s Children: an Anthology of Arab-American literature. She holds an MFA in creative writing from New School University and lives in Austin, Texas with her husband, the novelist and legal theorist John Greenman, and their son. You can read more about Zahie at www.zahieelkouri.com.