harvest season.

note: this is a long and personal post.  i’m a bit nervous putting this out in the world.  if you are uncomfortable with ovaries, follicles, speculums, or the fertility experience, you may want to skip this one.  i want to tell this story because i believe it is an important part of my cancer experience.  maybe one day it will help someone else.  for now, i know that everyone reading will be delicate with the information, and hold it in their hearts.  

when i was a kid, as we drove alongside the corn fields on the way to church, my mom would have us guess how tall the corn was, as compared to our body.  each week the corn would grow higher and higher – passing our knees, hips, shoulders, and eventually WAY above our heads.  and then one sunday, we would drive by, and it would be gone, cut lower than our ankles.  harvest season.

now, more than 25 years later, here i am with my legs up in stirrups, at a 90 degree angle – the lithotomy position – in a medical procedure room.  the first thought i have (drug induced) is… these poor doctors, why didn’t i shave?

it is a very different harvest season.

when i met with my oncologist to discuss treatment options, he let me know that immunotherapy did not have a lot of research in relation to fertility.  many of us know that chemo often impacts fertility, but because immunotherapy is so new, there is less information.  there has been some evidence that hormones can be impacted… but my oncologist made it clear that they didn’t really know.  since i want to continue to have options for motherhood down the line, we decided that i should delay the start of my treatment to harvest my eggs for freezing.

it was a long and emotional 12 days.  i had to manage my egg-spectations – everything changing moment to moment; day to day.

**********

day 1:  i’m back on OHIP.  i’m feeling optimistic and eager.  i have a cry in the bathroom… why?  its complicated.  i never imagined i would be ‘forced’ into harvesting my eggs in this way.  in general, i’m feeling rather uninformed about the whole process.  but i’m working to trust in the process, i need to believe that they know what they are doing.  it is day 8 of my cycle, which is not the ideal day to start, but they say that they can work with random start dates, and they do all the time.  i meet with the doctor, she tells me i will be on the ‘antagonist’ protocol.  it sounds like the character in a book.  she has me sign some forms.  i have blood work and an internal ultrasound.  it is only the second time i have ever seen my uterus and my ovaries.  they look like a beautiful home, hopefully someday someone will get to live there.  i wait in the waiting room.  it is cold.  and it is full.  it feels like half of ottawa is at the fertility clinic.  all sorts of people.  young, old, male, female, large, small.  i think of each of them, and their stories.  what brought them here.  do some of them have cancer, like me?  how many times have they tried to have a baby?  the fear and hope brims from their eyes.  i meet with a nurse who teaches me about how to give myself all the injections i will need to give.  THREE!  and the timing matters.  two in the morning at the same time each day.  one in the afternoon.  i tell her that i struggle with needles.  then i say, i guess i’m about to get over that.  i learn to inject myself, mix the solutions, the magical potions that will get my ovaries to work on overdrive.  i ask her more about the experience, and she doesn’t say much… other than that these are really smart doctors and i should trust them. i drive home, accompanied by a huge bag of drugs.  what would the police say if i got pulled over now?  i need to start injecting myself right away.  its 4:30 PM.  i get the needle ready, holding it at a 90 degree angle towards my belly, about to inject.  i think to myself, what if i faint?  i would fall off of this chair, which would be disastrous.  so… i go and set myself up on the couch, which would catch me if i fell.  i take a deep breath, bracing myself, and jab myself.  its not so bad.  i have a bit of belly fat to absorb it.  they say if you are really skinny it hurts more.  thank goodness for that slight bit of extra padding.  they say i may feel hormonal, emotional, tender, forgetful.  that evening, i feel a bit headachy, but that’s it.  i realize that when i gave those injections, that my body would have a steady stream of drugs for the next 13 months.  when will my body be mine again?

day 2 & 3:  i’m on a high.  giving yourself needless is really not so bad!  i had worked it up to be a huge deal…. and its just not.  you barely feel it.  i want to go to yoga, but i’m told: no inversions, no twists, no jumping.  they also say no running.  we don’t want those follicles/eggs to fall down your fallopian tubes!  i miss being active, but know it is just temporary.  

day 4:  whoa.  the hormones are raging.  i have a frustrating appointment with the psycho-social oncology program (that story is for another blog post), and i start crying.  and then i literally do not stop crying for the whole day.  it is like the taps have been turned on and then they do not stop.  the lady who is doing my bloodwork at the hospital to prep for immunotherapy notices and asks me if i would like a tissue.  i cry.  i get in the car and call my friend.  i cry.  i cancel all other activities for the day because all the crying has given me a headache.  i cry the whole way through my counseling session.  i have no idea a body can cry this many tears.  my dad takes me out for vietnamese food, and i cry into my noodle bowl.  now i’m not even sure what i’m crying about anymore.  

day 5:  i have a monitoring ultrasound.  they only see two follicles.  the ultrasound technician says, “good luck”, the way i am sure she says it a hundred times each day.  i wait for what seems like an eternity to meet with the doctor.  he sits down and says, “this isn’t great.  given you situation, we want you to have lots of eggs.  if you don’t grow more follicles by your next ultrasound, we may need to cancel the cycle.”  my heart stops.  cancel the cycle?  the thought of this not working had not even entered my brain.  i said, “there is a possibility that we will get no eggs?”  he said, “anything is possible”.  but this is my one shot before i start cancer treatment, i thought.  he looked at me, sad.  i didn’t cry.  i think i used all the tears in my body yesterday.  when i get back to the car, my brain jumps into overdrive.  what makes follicles grow?  i know acupuncture is good.  i am already doing guided meditation with circle and bloom, drinking chinese warming herbs, taking supplements, doing moxabustion.  but my acupuncturist is on vacation in france.  i research. i get on the phone. my acupuncturist responds to my email!  he recommends two different practitioners in ottawa who can see me over the next few days.  i picture the follicles growing, a healing light surrounding them.  i eat protein because i know protein makes healthy eggs.  my egg-citement turns to fear.  

day 6 & 7:  everything is about my fertility.  i wake up, drink my herbs, take my supplements, mediate, do moxabustion, and then head out for acupuncture.  i am easy on myself, sleeping a lot.  i felt a bit crampy and sensitive and take this to be a good sign.  grow follicles, grow, i urge.

day 8:  i go to the clinic for my monitoring ultrasound.  the drugs are supposed to hyper-stimulate my follicles to grow (there is an egg in each follicle) and i know this is the moment of truth.  has my body let me down?  when the ultrasound technician puts the wand in, she says, “look at those follicles”.  i release my breath.  i feel like i have been holding my breath for three days.  there are follicles?  yes.  there are follicles.  back in the waiting room, they come out and call my name.  at least three of us stand up.  this is not the first time this has happened – sarah was the most popular name of the early 80s.  you would think they would learn and use our last initial.  eventually i hear, “sarah f”?  i meet with the doctor, she explains that i have had some follicle growth and that we will not be canceling the cycle.  she says we may be able to get 4 based on the growth so far.  i am disappointed by the number but i say, “this is my shot, let’s do it”.  she prescribes me a few more days of drugs.  i am so emotionally exhausted that i go home and go to bed.  i need to sleep.

day 9:  i do almost nothing.  i convince myself my body is a follicle growing temple.  i continue my routine, my injections.  i get out into the sunshine and meet up with friends.  there is still a world out there that isn’t thinking about follicles.

day 10:  labor day sunday, i get up early to drive to the fertility clinic.  on the way there, i realize i have forgotten to give myself my 8 AM injection of cetrutide which suppresses ovulation.  the clinic had told me it was VERY important to take this at the same time every day.  it is 8:45, i’m 15 minutes away, and the needle is at home.  how could i have forgotten the most important thing?  i can barely see the road, and i can feel my heart beating in my throat.  i arrive quickly at the clinic and go directly to the pharmacy.  i start crying.  i sob, “i forgot, will this ruin everything?”  she is so kind to me, she reminds me that forgetfulness is a side effect of the drugs.  but i’m not a forgetful person!  she gets a prescription called in and gives me a room to give it to myself in.  she is kind and gentle and tender.  my pulse settles, my hands stop shaking and i go downstairs for my monitoring ultrasound.  the wait is long.  i’m reading a book of poetry in the waiting room.  it is the sun and her flowers by rupi kaur.  she writes like this:

now when i hear my name

called by the nurses

i know not to stand

i ask, which sarah?

i’m just one person

how could my name make me feel so 

generic

when i feel the opposite

so specifically me

is there something that each sarah in the world

has in common?  

some invisible connecting tissue

or yearning

or wanting

the ultrasound technician apologizes for running late.  i apologize to her for having to work on labor day sunday.  how canadian of us.  i scooch my way up onto the ultrasound table.  she inserts the speculum.  she measures each follicle.  she even calls one of them pretty.  i take it as a compliment as if i have some sort of control over their beauty.  i wait longer to see the doctor.  it is the same doctor as on friday.  she must have drawn the shortest stick to have to work the long weekend.  she said she is happy with my follicle growth.  there are around 5 and she says she we are ready to trigger.

day 11:  in the morning i give myself my last shots.  i will miss this ritual.  giving myself injections has become a comfort.  at 8pm i give myself the big shot, which triggers ovulation and the final maturation of the eggs.  i am to drink milk of magnesia before bed, still not clear on why.  i worry, what if my body misunderstands and moves too quickly and the eggs are gone by the time the retrieval happens on wednesday?  i never used worry about worst case scenario.  now i do.

day 12: i feel a bit crampy.  i am focused on healing.  i have a powerful reiki session.  she sends energy to my healthy eggs.  i feel heat, and tingly sensations.  i take a sedative before bed and stop drinking/eating at midnight.  i don’t feel worried because this is such a simple medical procedure compared to what i’ve been through.  plus, i know i have no control.  i succomb to sleep.

day 13:  retrieval day.  i wake up early, take another sedative and head in to the clinic, accompanied by my mom.   i’m not allowed to drive on drugs, which seems responsible and fair.  they call me into a room where i will be prepped for the surgery.  one of the nurses has just dropped off her child for the first time at school, and she can’t stop crying.  i comfort her.    another nurse is working to get a vein for my IV.  she tries four times.  she feels terrible.  i don’t mind.  i comfort her.  eventually they bring the doctor-on-call in, who is able to finally get a vein.  they bring me into the procedure room, get me set up, and start to pump me full of more drugs.  i feel badly for not shaving and then see the screen in front of me which shows the ultrasound camera.  “it looks like the moon”, i say.  blissfully unaware of my state.  i ask them about what drugs i’m on and they tell me that i’m on fentanyl and some other drug that i can’t remember.  they told me not to worry, that it was good fentanyl, and not like the fentanyl i have read about in the news.  at this point, i’m feeling great.  when they insert the needle/ultrasound, i feel some uncomfortable pressure – once on the left and once on the right – but otherwise it is over fast, and it is relatively painless.  as they suck each egg out, they pass it to someone who is in another room, and i can hear her confirming delivery.  they get me into a wheelchair and i go back to the prep room, where i drink a ginger ale, and come down from my massive high.  they pass me a piece of paper which shows the number of eggs they took out.  i see a number ten on the paper, which must be a mistake.  i tell the nurse that it can’t be true, but she says it is.  i am overjoyed and shocked.  how did five follicles turn into ten eggs at the last minute?  are we sure those are my eggs?!!  after i’m back to myself, mom drives me home and i take a long nap.

day 14: the clinic can only freeze mature eggs.  so, today is an important waiting day.  they will call me today and tell me how many eggs actually made it to being frozen.  i don’t have a local cell phone number, so they need to call me at my parents house.  of course, i don’t hear anything until the end of their work day.  i decide i will be happy with any number larger than zero.  my immunotherapy starts in four days, so we don’t have time for another cycle.  when the phone rings, i jump for it.  we get about 4 calls from solicitors.  eventually, the doctor-on-call calls, and tells me she has good news.  nine of my eggs made it to freezing.  she explained that fertility is unpredictable, and that this can happen on occasion, where we get more or less than we expect based on scans.  i’ll take it!  i have nine glorious mini-me’s, cryogenically frozen.  i am overflowing with gratitude and happiness.

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as summer turns to fall, the air cools, and there is a hint of the leaves changing color, it seems fitting that my own harvest season would be complete.  it is not a process that i ever imagined i would go through in this way.  but it was a choice that was in line with my values – keeping my options for motherhood open for the future.  i found the process to be emotional and very medicalized, but not scary.  considering the first ever “test tube” baby turned forty this year, we have come an incredibly long way with modern medicine, and interventions to support all types of fertility issues – including women and men in the unfortunate situation of receiving a cancer diagnosis.  making this decision did delay the start of my treatment by a number of weeks.  at times i worried about this.  however, i was able to enter treatment clearheaded and without regrets.

i see my future: one day, with my own kid(s) in the car, we will measure the height of the corn against our own bodies.  passing our knees, hips, shoulders, and eventually WAY above our heads.  and i will tell them the story, of my own harvest season, and part of the medical miracle that brought them to me.

*this photo was taken in naoshima, japan in june 2014.  naoshima is an island known for its art installations.  this pop art sculpture is an iconic yayoi kusama piece and in many ways become the symbol for the island.  pumpkin harvest season is coming soon.