I Have Been Googling Melanie Klein

I had a superb session with my long-standing infertility counsellor last week, walking away from our discussion feeling a growing conviction that, if I ruled the world, I would doubtless take a sauce-for-the-gander approach, and advocate Psychotherapy For All!  My stress load has lifted, quite significantly. (You may, in fact, cheer a tiny hurrah! for little victories! along with me if you like.) 

At the centre of our discussion was my fear and outright anger that I had been unrelentingly manoeuvred by mulish ovarian circumstance into agreeing to utilise the uterus that, I considered, had fired bullets that Harry failed to altogether dodge. And there was my lovely other uterus, sat so near and yet so bloody far – shackled to an ovary that barely registers one biological notch above vegetable. The Harry-Uterus-of-Gunky-Unpleasantness, of course, is connected to a sprightlier, more animate gonad.

(IVF, which alone can resolve the complicated logistics regarding reproductive geography, is not a option we are currently considering because 1. my Consultants like the Harry uterus (that was my tearing hair you just heard), 2. downregulation provoked my cardiac arrhythmia to begin with, and I am highly nervous about what another application of hormonal starvation would do to the poor organ, 3. I reponded inversely to downregulation (20mm follicle) and stimulation (zippetyzilch) on both my previous IVFs, and 4. it costs helluva lot of money that although, yes, we have, neither of us is convinced we should spend at this stage. We are, after all, planning to effectively incapacitate myself for Proper Paying Fulltime Work for several more years if this is successful.)

Anyhoo, I was gently invited to consider that my feelings of wistful frustration concerning my foiled but desperate wish to use my left-hand, non-Harry-housed, ‘better’ uterus, may be originating as an inverse result of the horrors of my precarious pregnancy and Harry’s premature birth. I have, it seems, decided that my right-hand Harry-uterus, with its endometrium of pure tar, should be labelled ‘Black, Black Death’. Might I, it was suggested, have applied a ‘White’ label to my left-hand uterus in response to this?

Why, yes. Yes, I think I absolutely bloody have.

There was more analysis of the topic, which would be excessively tedious for you, but suffice to say that I currently feel a good deal more benevolent towards my innards than I have for some years. Having thus reduced the situation to a rather simpler scenario of Practical Fear Management for Dummies, I was encouraged to email my Consultant – which I would likely not have done without urging, as I have to overcome my initial diffidence about tabling Stress as a legitimate medical concern when it’s mine. I view other people’s stress as a major holistic player, but my willingness to paddle my own emotional canoe over rough rapids can be ridiculously pronounced.

Anyway, I’ve just emailed. Here it is, and I am, as thay say, awaiting a response with interest.

Dear Dr. Very Kind and Beautiful Lady Consultant X,

 Thank you for seeing John and I at X Private Hospital before Christmas and discussing the ways forward following my laparoscopy and hysteroscopy. We are looking forward to our forthcoming IUI cycle and I’m sure we will see you in clinic; but before we embark upon treatment, I wonder if I might outline a difficulty I am now confronting that your obstetric colleagues may be able to assist me with.  

 I have been experiencing some acute anxiety, not concerning the treatment cycle or the result of it, but about the possibility that a pregnancy might go on to replicate the difficulties that I encountered with my son Harry (whom we expect will receive a formal diagnosis of ataxic cerebral palsy). My antenatal care was given by X Local Hospital and community, and from around the start of the second trimester, I repeatedly relayed to my midwife that I could hear, on an oft-daily basis, skipped heartbeats and acute decelerations on my home Doppler. I was, frustratingly, quite unable to convince her that I was using the device correctly; she naturally assumed I was unusually anxiety-prone on account of my previous infertility and miscarriages – quite rightly, of course – but I was, as it happens, hearing my son undergo frequent episodes of foetal distress. It was not until the beginning of my third trimester that Harry’s heart decelerations were eventually picked up by CTG whilst I was inpatient at X overnight following a bleed (I had regular bleeding episodes of undetermined origin), and my Consultant was alerted to the issue at some speed. 

The feeling that I was unable to enlist any support in my concerns for my child for a large sector of my 33 week pregnancy, despite being categorised from the very beginning as high-risk and receiving consultant-led antenatal care, is one that I have subsequently found very difficult to put behind me. I fully appreciate that there are no straightforward solutions to a <24 week pregnancy that is not proceeding particularly well, and that ultrasound monitoring (which I did receive quite regularly, albeit by a bemused radiographer, who was just as unsure as we were quite what markers she should be looking for) may be all that can be practically offered – but I nevertheless feel that my pregnancy (or, certainly, my stress) could have been rather more actively managed. I am very pleased to be now taking low-dose aspirin, with heparin standing ready, and I am naturally hoping very much that (should our upcoming IUI treatment be successful, and I progress as far as a second trimester) I will not re-experience the spectres of foetal distress, IUGR, premature birth and particularly the horror that is NICU, but I find myself, in light of my uterus didelphys and broadly unhappy reproductive history, unable to be optimistic on the topic; consequently, I am now considering how best to manage my fear. I am, sadly, not the type of person to find that ignorance is bliss, nor take much comfort in considering the evil sufficient to the day thereof!

As a result, I think I would find it reassuring to discuss with the high-risk obstetrics team at Big Regional Hospital X how they might conceivably anticipate approaching my care management should I happily be in a position to be referred onwards to them this Spring, and, should history unfortunately repeat itself in the middle and later stages of pregnancy, what, if anything, they might possibly manage less conservatively this time around. I realise that there are no definitive answers or categorical reassurances to be given, and expect none. However, being at ease with my position of A) poor odds and B) helplessness regarding the influence of a positive pregnancy outcome, requires a level of cognitive fatalism I unequivocally do not possess. I hope that acquiring a better understanding of what investigations and measures could possibly support a precarious pregnancy will reduce my anxiety in the face of it, and enable me to commence our IUI cycle in a little less conflict of mind than I am in at present. I am happy to have a private referral if necessary, and I sincerely hope that my worries prove to be thoroughly misplaced.

What a lengthy explanation! And I’m so sorry to trespass on your time yet further, but this last item is a quick one – I have spoken to Secretary X earlier today regarding my very great curiosity regarding the photos taken during my laparoscopy, and I think she is intending to speak to you regarding their whereabouts; if they are readily accessible in my notes, I would (I think?!) be highly delighted with them! 

We are in clinic for our nurse information session 9am this Thursday 3rd; I have also listed full contact details below.

Thank you very much indeed for your time!

Kind regards

Mrs. Hairy Farmer

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