The Waiting Room

(Head over to the Stirrup Queens if you’d like to read more of today’s #MicroblogMonday posts.)

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The waiting room at my OB’s office has one door on the right and one on the left. Whenever I come in for an appointment, I am first called in through the door on the right, where I have a quick ultrasound and am given a little packet of photos before being sent back out to await being called back to meet with my doctor through the door on the left.

Each time this has happened, I’ve been a bit unsure of what to do with my ultrasound photos while I wait. I want to pore over them right away, examining every precious detail with my husband, but I am in the middle of a room full of women who are at that same office for, I imagine, very different reasons; I don’t want to flaunt my happiness in front of anyone who might be hurting. To be more sensitive, I could simply slip them inside my purse and save them for later, but I don’t want them to get wrinkled or torn.

So, I usually glance over the photos briefly and then hold them quietly in my lap. I love seeing those grainy images of our new little person, and I love receiving a reassurance at each appointment that s/he is growing and healthy. OB offices haven’t always been such an easy place for me to sit, though, and I can’t help but think that those two doors must have witnessed some of the highest of highs and the lowest of lows over the years, with hearts full of emotion hidden behind the still faces of so many who sit and wait in that room.

Updates

Well, it’s been awhile since I posted on this little corner of the internet. I’ve had plenty to say and didn’t mean to completely disappear, but I have been running in survival mode for the past couple of months and just haven’t had the energy. Between the constant nausea, vomiting, and fatigue, I’ve been putting any energy I do have into simply keeping my head above water at work and school.

It’s been really difficult physically, but I’m happy (and relieved) to say that I’ll be 14 weeks tomorrow and have made it through the first trimester! Over the past two weeks, I have been having more clear days when the fog seems to lift and I feel that I can actually function once again, but the morning sickness hasn’t ended yet and other days have still been pretty darn miserable. Now that I’m a bit farther along, though, I feel like there is a light at the end of the tunnel, and it definitely has gotten a little easier.

The fact that I am pregnant is still so surreal to me. After so many months of trying, I almost forget sometimes that this is really happening and that there really is a little human being growing inside of me. I have my ultrasound photos up on the wall next to my mirror in my bedroom, and seeing them everyday helps me keep things in perspective as a constant reminder that suffering through all of the unpleasant symptoms really will be worth it in the end and that this is exactly what I have wanted for so long.

We have told quite a few people at this point, and that also helps make it seem a little more real. Telling people has been an interesting experience all on its own, though. One common response has been to remark on how perfect the timing is – and this has come both from those who had no idea that we had been struggling for so long and from a few that did know.

I definitely agree that the timing is convenient, so I can see why those who didn’t know our story might think that we planned things this way. I suppose it makes sense to them since I am finishing up school this spring and summer, so it will be easy to take time off when the baby comes in the fall. It makes me laugh, though, to think that they are commending me for my great family planning skills, as though I had any say in the matter.

And, from perhaps a more cynical perspective, these comments make me cringe inside because I certainly feel that the timing of this pregnancy would have been so much more perfect and convenient two and a half years ago. It’s especially hard to hear this from those who knew our struggles, because in a way it almost seems as though they are dismissing everything that we went through while trying to get pregnant.

Yes, I am overjoyed to be expecting and to not be going through the excruciating heartaches of infertility any longer. Yes, I am beyond grateful that I did not have to spend more money or go through more invasive treatments in order to conceive. However, our past experiences haven’t just evaporated since we finally are on our way to having a baby. Infertility became a part of me over those long years. It changed me, and its shadows still impact me. I think they always will.

In a way, I suppose I am grateful for that. I know that I will forever be more sensitive to those struggling, and I am glad that my experience will allow me to be more aware and thoughtful as I become a mother. I don’t know that I will ever say I am grateful that I went through infertility or that I’m so glad things worked out the way they did these past few years, but I can at least acknowledge that I have learned and, hopefully, will have something more to offer as a result.

Unexpectedly, Wonderfully, Joyously

Hello, world! I haven’t been around this corner of the internet much lately, but I thought I would stop in today because I’m pregnant.

Those are two little words that I didn’t think I would be saying this soon or without many more tears and heartaches, but they are unexpectedly, wonderfully, joyously true. As of yesterday, I am 7 weeks pregnant with a tiny little embryo that (I pray) is growing larger and stronger each day.

I took a pregnancy test a few weeks ago, against my better judgment, because… well, because I had a stash of them in my bathroom cupboard, and it’s hard to resist sometimes. I didn’t have my hopes up, but I had developed a habit of testing at the end of most cycles, and it was that time again. After dipping the stick, I sat and watched it for a minute or so. When no second line started to show up, I sighed and tossed it in the trashcan. I had seen so many negatives before, and I didn’t have any reason to think this one would be any different.

A couple hours later, though, I was straightening up the apartment and looked at that test one more time when I was putting a couple things away in the bathroom. Out of habit, again, I reached for the test just to make sure that it really was negative, and I couldn’t believe my eyes: there was the faintest of faint pink lines on that little test. I had seen so many starkly blank tests before – never a glimmer of a positive, not even an evaporation line – that I knew this one was different. I immediately started shaking, and the tears weren’t far behind. I called my husband in to see if he saw the line as well. He wasn’t quite as ready to believe right away, but I knew in my heart that it really was true – I was pregnant.

I took another test that night and got another positive squinter. Early the next morning, I used a digital test that I had on hand, and that left no doubt whatsoever; I climbed back into bed and showed my man the proof. There it was, in plain English: Pregnant. Exactly 3 years after I stopped taking birth control pills and 29 cycles since we started actively trying and hoping for a baby, our dreams were finally coming true.

I worry on occasion that something might still go wrong, but from the beginning I have been telling myself to simply focus on the here and now. Right now, I am pregnant, and I am soaking that up.

One thing that I wasn’t really expecting, but perhaps should have been, is the different twinges of guilt I have felt here and there over the past few weeks. I have found myself feeling guilty, on occasion, that I have reached my happy ending when others have not and perhaps will not. I have no idea why it worked for us this cycle, when it hasn’t so many times in the past. I have no idea why it finally happened, when we had such low odds and when our doctors weren’t giving us much hope with regards to trying naturally. I have no idea why this happened so easily (relatively speaking) for us, when so many we know have gone through much more invasive and difficult procedures in hopes of achieving a pregnancy, and not always successfully.

I am grateful that I am leaving the world of trying to conceive behind me, but I also feel guilty for feeling grateful while others cannot. I know there is nothing I can do to change their situations, but my heart still breaks for those who are struggling. I want to be sure I don’t forget how excruciatingly difficult infertility is, now that I am tentatively moving on to the other side.

From a different perspective, I have also run into a problem of feeling guilty for not absolutely loving every second of being pregnant so far. To be honest, morning sickness has hit me hard over the past couple of weeks, and I have had some absolutely miserable days of trying to cope with constant nausea, vomiting, and fatigue. I have found myself wondering how I am going to do it, how I am going to manage to continue with my normal schedule when I feel like I have no physical or mental strength. I have had to run out of my classroom multiple times over the past week so that I could throw up in the nearest restroom, and it seems so daunting to consider that this sickness is likely going to last throughout the rest of the semester – my last semester of both taking and teaching classes.

In those moments on the days when I hadn’t been able to keep even a sip of water down and found myself exhausted and crying on the bathroom floor after vomiting yet again, I found myself wondering why this was so difficult for me. Over those years of waiting and wishing for a baby, I had envisioned that I would have a wonderful pregnancy and would never complain about a single symptom, since they would just be reminders that my little one was real and growing. Well, I guess you could say that reality has given me a wake-up call, and it hasn’t been easy.

I am learning, yet again, how important it is for me to be compassionate to myself as well as to others. Although I know that this will all be more than worth it, I have to remind myself that it is still okay to acknowledge that dealing with this constant sickness is truly hard. Don’t get me wrong – I wouldn’t trade this for anything, and I am more grateful than I can say for this miracle pregnancy. It is the most important thing that I have ever wanted, and even though it is hard physically, this is exactly where I want to be right now; there is no way I would go back or give this up. I have a little one on the way, and I can be strong for this sweet babe who will soon be making me a mama.

Dreams

I had a baby dream last night.

It wasn’t the first, and I’m sure it won’t be the last, but for some reason this one left me with a feeling that was hard to shake.

In this dream, I had had a baby but then had been sent home with my husband because I wasn’t able to keep him yet. I went back to my normal routine and nearly forgot about having had him at all, until one day the memories all came rushing back to me and I insisted on going back to the hospital to find him. We gathered up bags filled with binders upon binders of our medical records and carried them, staggering under the weight, into the room where we had last seen our baby. He was no longer there, and we felt completely hopeless. We sat down in that room and didn’t know what to do until, eventually, someone pointed us to a distant room down a long, dimly lit hallway. We wanted to leave the bags of records behind, but had to pick them up again and take them with us down the hall, where we found our baby lying in an incubator. I dropped the bags and rushed over to him, reaching out so he could grasp my finger. We had found him. In that moment, I wanted nothing more than to pick him up and take him home with us, but I suddenly knew that it was not possible. My baby was there, real and alive and warm, but I could not have him.

When I woke up, it took me a moment to realize that this had not actually happened. It had all felt so vivid and tangible, and it was almost a shock that I didn’t have a baby lying in a hospital somewhere.

The dream hung over me like a cloud. Despite the fact that I have never had a physical baby to mourn, the feelings – the hopelessness and confusion and devastation – were still very much real. The fact that our journey of trying having a baby has been fraught with uncertainty and dead-ends and piles of intimidating medical records is real, and the fact that taking a break makes me worried that I will forget how badly I want this is also real. Above all else, the fact that I wish more than anything that I could leave the shadows of infertility behind us and hold that baby in my arms is absolutely real.

An Old Spoon

(I’m linking up with the Stirrup Queens today for #MicroblogMondays. Head over there if you’d like to read more #MicroblogMonday posts!)

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I have heard many stories from my mother-in-law about my husband as a little one. Apparently, he really gave her a run for her money, employing all sorts of tactics such as holding his breath until he turned blue, climbing on top of the refrigerator to get to the medicine bottles, and refusing to eat anything at all for long periods of time.

After we had been married for a year or so, she gave me an old plastic spoon shaped like an airplane, the only utensil that had successfully convinced her stubborn baby boy to actually take a bite of food. She had held on to the spoon for all those years and gave it to me so that we could someday use it with our own babies.

I took the spoon home and placed it in the back of our silverware drawer, thinking it was cute and that we would eventually pull it out and use it. The thing was though, as time went on, that little blue airplane started to look sadder and sadder, until I hated seeing it sitting there, unneeded and unused, each time I reached for a fork or a butter knife.

That old spoon is now buried deep inside a storage drawer, hiding out in a safe place until an unknown time in the future. I suppose we’ll take it with us wherever we move, and someday, maybe, we’ll have a use for it.

Spoon

Bills

So… I just need to vent for a minute. This gets long and ramble-y (sorry), but I just needed to get it out there.

There are are many things in this world that I don’t understand, but one of the most frustrating for me is the US healthcare system. Here’s a recent example from my life:

I have had two separate HSGs done in the past few months, first with an OB-GYN and then with an RE (Reproductive Endocrinologist). Even though I was repeating the same test, these were two vastly different experiences, both in the outcome and in the way they were billed. Despite not covering infertility treatments, my insurance does provide coverage for diagnostics, so I had been told by each doctor’s office that the HSGs should be fully covered.

For my second HSG, the one with my RE, this turned out to be true. My insurance company was charged $1,138 for the entire procedure, and they paid every penny, except for the $40 copay that I have with each appointment. Maybe it’s a testament to the fact that the billing office at the fertility clinic truly knows what they are doing in this area or the fact that they work hard to help their patients navigate the finances of infertility, but this was a relatively painless procedure, physically as well as financially.

The first HSG was a completely different story. Not only was the test a failure, but trying to work out the billing has been ridiculous. The initial bill was higher than the one from my RE, which I suppose was to be expected because this HSG took place in a hospital, so I had bills from the OB-GYN, the radiologist, and the hospital itself. The total sent to my insurance company was $1,959. I still haven’t figured out all of the details with how this HSG was coded, but somehow it was submitted in a way that resulted in the insurance company considering it a surgery to treat infertility, and therefore they only gave me partial coverage.

Between the three different bills for this first HSG, I ended up being held responsible for $1,088, while insurance covered the rest. Now, I know this is just a drop in the bucket in the world of infertility treatments, but it seemed like a pretty big drop to me. It all adds up so quickly, and I was not happy to receive these bills after being told by my insurance and my doctors that it would be completely covered. From what I’ve seen online about how much to expect an HSG to cost, my bills seemed pretty high anyway. (Also, how was the RE able to code everything so that it was completely accepted by my insurance, while the OB-GYN’s office wasn’t? I am still trying to wrap my head around the fact that my repeat test at the fertility clinic, the one I worried my insurance would think was non-essential, was completely covered, while the first one wasn’t. They were the exact same procedure!)

Anyway, I had a bill from the OB-GYN for $750. This charge was apparently for the catheter and the dye insertion, which is a big chunk of what my insurance refused to pay for. When I called the billing office to see if there was any way the codes could be changed so that the insurance company would accept it, I was cheerfully told that it should have been covered 100% – they had even checked this with my insurance beforehand – and that the insurance company must have made a mistake.

And thus began a 2-month long roller-coaster of negotiations that I have (hopefully) just ended.

When I called my insurance company, they informed me that based on the codes put in by my billing office, there was nothing they could do. They hadn’t made a mistake at all; my plan simply didn’t cover the procedure. Of course, they couldn’t tell me why it was considered a plan exclusion, because they weren’t allowed to discuss what was in my file; I would have to check with the doctor’s office for more details about how it was coded.

When I called the billing office again, they told me that an HSG wouldn’t have been covered anyway, because it was more than a simple x-ray. Clearly, it’s more of a surgery than a radiology test. (Even though this was the opposite of what they had told me before! Even though my second HSG was covered! And does anyone want to explain to me how an HSG is a surgery? That makes no sense to me, either.) They said that they would send a message to the insurance company and see if there was anything that could be done. This would take 4-6 weeks, so I’d have to wait patiently to see what happened.

I felt like everyone was giving me the run-around, and no one was actually trying to figure out if there was anything that they could do to help me. Then, sometime last week, I got a new version of the bill in the mail. Apparently the OB-GYN’s office hadn’t gotten anywhere with the insurance company, but they had decided to give me the discounted rate that the insurance company would have paid if they did cover the procedure. (This also makes no sense to me – if the insurance doesn’t cover it, why do they have a set price for a discounted rate? This is a private health plan, so I don’t think they have other versions that would include infertility. But, who knows, maybe they do?) So, now instead of being billed for $750, I was being asked to pay about $530. Better, I guess, but still a bit pricey.

I finally got up the courage today to call the billing office back. I was starting to think that I would probably just have to pay up, but I wanted to ask one more time why it had been coded the way it was and why I had been told that it would be covered if it wasn’t. After getting nowhere with the first person I talked to, I finally got through to the billing manager. She gave me the same speech, telling me that this was how they always coded HSGs and that the insurance just didn’t cover it. I finally said that I understood that there was nothing they could do for me, but I was confused why I had been told, when I first called all the way back in November, that it should have been covered and that the insurance had made a mistake. Why was I hearing different things every time I called?

She changed her tune at that point and said that there actually was something she could do. She said that my insurance company must have tacked on a lot of extra costs for overhead because the HSG took place at a hospital. She was actually surprised to see how high my bill was, since most other insurance companies apparently have a site-of-service differential that would have been used to reduce the cost to about $100 dollars, but mine doesn’t. (Or just didn’t use it? I’m not sure.) So, she said that she could reduce my bill so that I would only be paying $100, the same as what they would normally charge to a different insurance company.

So. On the one hand, I am VERY grateful that the charge has been reduced. On the other hand – I don’t get it! Why is the amount that my doctor bills me set by my insurance company, if my insurance has already refused to pay for the procedure? Why were hospital overhead charges tacked on to my bill if the bill was not for the hospital at all, but for the regular OB-GYN office? (I have completely separate bills for the hospital and radiologist.) Why do uninsured patients automatically get higher rates than insurance companies? And if the billing office really did have the ability to reduce my $750 bill to $100, why didn’t they do this in the first place???

Here’s another example of frustrating heath care costs – my husband’s first semen analysis, which was ordered through a different OB-GYN and conducted at a local andrology lab, was billed to us at a price of $630. We were able to get it covered by insurance eventually, after a lot of back and forth with the insurance company, but we still paid $240 with the deductible and copay. This is a ridiculous cost for a simple lab test! After switching to an RE, we found out that the self-pay price at our fertility clinic is only $25.

It seems like such a mess to me. I know there’s a lot I don’t know about insurance and health care, and I also know that all these people I’ve interacted with are probably trying to do their best in their jobs, but the cynical part of me feels like they are just arbitrarily making up numbers to charge me, hoping that I don’t notice and call to challenge them. I don’t understand why the prices are so different from one provider to the next – or from one insurer to the next – and how insurance companies can accept or deny the same procedure based on how it’s presented to them. I know that good healthcare is expensive and worth paying for, but so many prices we have been given seem so outrageously inflated.

I’m deeply grateful that I have health insurance coverage at all, but it is always, always a frustrating experience to have to deal with billing issues. Infertility – or any health issue, for that matter – is difficult enough without also having to face a crippling financial burden and having to be your own advocate in the face of impenetrable medical companies that seem to be watching out only for their own bottom line. I don’t know what the answers are, but I can’t help but feel that there has to be a better way.

Edges

We had my husband’s brother, his wife, and their 8-month-old baby staying with us for about a week at Christmastime. We were happy to have them; it was really nice to see family and spend time together. In all honesty, though, it was also difficult to navigate having someone else’s baby in our home for the holidays when we had been struggling so much throughout the past year.

I know that it was also difficult for my brother- and sister-in-law. They know what we have been going through, and I know that they would never want to hurt us or flaunt their situation. I also know that they have their own set of challenges, and it would not be fair for me to resent them or their baby.

For most of their stay, I think I did pretty well. It was surprisingly not difficult to set my feelings aside so that I could focus on just enjoying the holiday and being with family. Every once in a while, though, it was hard. I knew from the start that our week would revolve around the baby and his schedule, because babies are pretty demanding little people, but it still was hard to have our schedules dictated by a baby that did not belong to us. It was hard to have our home filled with all of the baby supplies that we desperately wish we needed for a child of our own. It was hard to have so many constant reminders of what we don’t have but want so badly.

The first morning they were here, I woke up to my alarm, as usual, to take my basal temperature. As I lay there listening to the beeps of the thermometer, I also heard the gurgles and babbles and cries of the baby in our extra bedroom, the room that was supposed to be for our own little one, the room that we use as an office because it’s less painful than having it sit empty, waiting for a baby that never comes. That first morning, I remember thinking how surreal it was to have the life I was actually living so starkly juxtaposed with the life I wished I were living.

My experiences with infertility have left me feeling pretty broken, and I know that they have etched sharp and jagged edges on my personality. It’s so easy to become bitter and jaded, and that’s been a real part of my experience recently. This is not the person I want to be, but in some ways, it is the person I am right now. I’m working to overcome this, working to let the softer and more humble parts of me rise to the surface more often. It’s hard though, and I know I need to be patient and compassionate with myself as well as with those around me. I am a work in progress, an imperfect person just doing my best to keep my head up in spite of the challenges life has thrown my way.

So, even though it was hard at times, I am grateful that our family members were willing to travel so far to come visit us. I am grateful for the happy memories we made together, and I hope they outweigh any negative ones. I am grateful that they were willing to share their little one with us, and I am glad that it provided us with a reminder of why we are continuing on this path, why we are still fighting to have a baby of our own instead of giving up and moving on. And, as cheesy as it may sound, I am grateful for family and friends who love me, jagged edges and all, because that is truly what makes this life worth living.