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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40 Responses

  1. Wow. What an eloquent letter. I hope they can offer you some strategies, both for dealing with dismissive staff and for dealing with your concerns about pregnancy in general.

  2. A big hurrah! For big victories!

    What a letter.
    You’re my hero.

  3. I love your ever-so-politely worded summary of “and what the fuck are you going to do this time, morons?”

  4. I’m with Jenny F. Scientist. Plus, I love her name.

    -Dr. May U. BiologyProfessor

  5. Bravo!! Now fingers crossed they’ll get their fingers out of their arses and monitor you better next time (again, crossing fingers).

    (incidently, they had a woman with uterus didelphys on Embarrassing Bodies last week. I would love to know what you thought of what they told her.)

  6. You are so amazingly possessed of a calm ability to letter write. Make that Letter Write. I tremble in awe.

  7. Brilliant letter. Calm and eloquent. I would be tearing m hair out and having screamy-screams all over in the page, were I in your shoes. Or your pants. Wait, that didn’t come out right.

  8. Well if that doesn’t make the Beautiful Lady Consultant sit u and listen nothing will.

  9. Your letter is a masterwork of articulate, elegant firmness. I have a little crush on you.

  10. Excellent letter. Calm, convincing and totally cool!

    In assvice corner my personal experience has been that once you have had a difficult or worse pregnancy and birth they are all over you like a hawk in subsequent pregnancies. And so they should be. I would definitely bypass local hospital plus community care and head for Mammoth Regional Teaching Hospital. It is absolutely your choice to do that. Most will let you self refer. There you can get the regular scans from an FMU staffed by docs rather than scan people that you need. They may not be able to actually do much more than regular scans for the early weeks but they can at least offer that. Then you’ll get access to the super specialised consultants and there is nothing they like more than the “interesting” case. It might be a bore doing appts there travel wise but peace of mind wise I think worth it.

    • You are spot on with the travel. 31 miles from our door to theirs, plus £3+ to park. I dread hospitalised bed rest: can’t bring myself to consider how I & Harry would cope.

      • Um, if the Mammoth Regional Teaching Hospital is the one I’m thinking of (catering for the female persuasion?) I live round the corner from it. Can offer coffee, cake, lifts so you don’t have to park etc if necessary. Just saying.

  11. Three cheers for therapy, and less stress, and that masterly letter! I hope Ms. Consultant gives it a worthy response.

  12. Brilliant letter. That has given them the iiii and ttttt now I hope they dot and cross where applicable!

    What I really hope though is that your next pregnancy will be incredibly dull and boring and produce a little cherub at precisely 40 weeks 😉

  13. tiny hurray (repeating every hour of the day). Maybe I should see your infertility counsellor. Or at least have someone help me to waterproof my emotional canoe…

  14. Amazing letter, I hope that she replies soon.
    I’m still confused as to why they like the Harry uterus so much (OK, I get the ovary situation) but surely the endometrium etc is somewhat less than ideal?
    Being married to a cardiologist, I feel compelled to ask a) what the arrythmia was and b) did they do anything useful about it?
    Keeping all fingers crossed, as always.

    • Arrhythmia ignored completely (wurl, GP reluctantly did a 5min ECG -‘Nowt wrong at ALL, Mrs HFF!’ I very much doubt you’re having arrythmia!) until they found (in passing) that I had a transposed IVC. That, in conjunction with a upcoming abdominal operation and me complaining of an increasing number of baby-bird-in-chest sensations bought me a 24 hr ECG. I was terrified I’d have none, but I counted 3 palpitationy-things, and so did the ECG, thank God. *pokes GP in eye* The good news is that they are benign, although I DO wish the consultant hadn’t used the term ‘momentary arrest’ when he pointed to the guilty bit of chart print-out. I forgot to ask for a proper diagnosis, but I suspect he would have said common-or-garden PACs. The bad news is, they are hormally linked. I am having a good deal more of them lately in any event, and a pregnancy will make them dreadful, I’m sure. Even though I KNOW they’re harmless, when I have a big one that knocks my breath away, followed by several seconds of Confused Arrythmic Flutter, I always think… am I… going to .. DIE? Fun times!

    • Biopsies were normal… damnit!

      • Of course, I wanted ONE normal biopsy. I was hoping the Ute of Doom would come back reading ‘tar’. There is a possibility I might be wrong about it all.

  15. I now feel compelled to add that (a) I was on hospital bed rest with Dee for 12 weeks so I was terrified it would happen again with Buddy and (b) then with Buddy we watched like hawks for a shortening cervix and instead were taken up with my placenta previa so of course it was (c) the amniotic fluid embolus that ran away with first prize for the ThisPregnancyIsShit prize. Moral: whatever you think will go wrong will merely fill you with terror long enough so that other developments may surprise the hell out of you.

    Cynical? Me? Nah.

    I should also add that I firmly believe that the excellent prenatal care that my previous pregnancy horrors bought me with Buddy is the reason we are both here today. Forewarned is forearmed.

  16. I’m delighted to be able to lay on even more flattery and tell you that your wonderful missive had better be read and acted on by Dr. DVKaBLC or I might have to buy an air ticket and come over there and deal with her on your behalf.

    I try to manage my stressy thought processes by asking myself if what I’m thinking is actually true. I’m constantly shocked by how often my answer is NO, DUMB ARSE!

    Good luck with it all. x

  17. Lovely letter/email – really eloquent, as others have alread y said. But…but… but….if this is really the text you sent, rather than a blog reworking, and at the risk of being the only less-than-100% positive feedback on the blog:
    If you were the kind and beautiful consultant, struggling to keep on top of 100 emails a day in addition to seeing patients, operating and generally doing medicine stuff, I worry whether the whole of your carefully worded plea would get read. If it’s anything like working in an office it definitely wouldn’t… In my experience, short and very clear (ie non literary) statements/questions are so much easier for busy people to focus on (and therefore answer).

    Hoping I’m wrong, of course. Good luck.

    • Ehhhh… no, you were spot-on!

      I DID think about adding a PS apologising for the goddamn LENGTH of it, but I then got into a thought loop about the fact that that would add EVEN MOAR words and… yeah. She didn’t read it all, I know. Just enough to get the gist. I am incapable, it seems of brevity. Probably why Twitter and I don’t get awfully well. And why I earn my living, such as it is, from sales.

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