MY DAD IS NOT GIVEN to excessive displays of emotion. He is calm, reassuring, extremely measured about all things. Before he retired, he worked for forty years as a solicitor specializing in conveyancing, the least theatrical corner of the legal profession. The only subjects on which I have ever heard him voice an intemperate opinion are the filthy hot dog vans in central London, which he would like to firebomb, and Boris Johnson (“a toe rag”). Before leaving London, I do the one thing guaranteed to make my plan real; I mention it to him. Once you involve a parent, you open up a channel of concern and inquiry, a drip drip drip that it will be almost impossible to divert or fob off. It’s like promising a toddler a treat; change your mind and you’d better have your story straight.
“So the plan is,” I say, “that next year, or something like that, I’ll do what L has done and try to get pregnant, because I’ll be turning thirty-nine, time to crack on, makes sense if I want to have children, which I do, always have in fact, actually. Yup. So. That’s.”
We are on the road to Heathrow, driving around the southwest corner of Turnham Green just before Chiswick Town Hall. “Hmmm,” says my dad, looking straight ahead.
I glance at him sideways. My dad is in favor of L because I am in favor of L, and also because he likes her. Along with Marion, my dad’s partner, he has been enthusiastic about her baby. On the other hand, throwing a second baby into the mix without putting the relationship on a more formal footing is a challenging bit of news to absorb. My dad is liberal, but he is also a sixty-nine-year-old man who was married to my mum for thirty years. I wonder if even for him this mightn’t be a step too far.
Nothing more is said about the baby that day, something that might worry me if I didn’t know him so well. My dad has a habit of going quiet at the time of a major revelation, then chiming in later when he has had time to think. I know he’ll be concerned about the logistics, not only of how I might cope alone with a baby, but of how I might cope alone with a baby so far from home. He’ll wonder what my mother would have said and how she would have wanted him to respond. I smile as I consider this. The big gap in my mother’s liberalism was around the raising of children; she was against people having kids outside of marriage. She thought pedophiles should be put to death or castrated. I don’t recall us ever talking about gays having children—it wasn’t around much as an issue in 1980s Buckinghamshire—but in spite of the fact that most of her best friends were gay men, my sense is she would have been disapproving. (In this she would, I think, have made a distinction between the suitability as parents of two men and two women.) For all her eccentricities, my mother idealized or even fetishized the traditional nuclear family, which she saw as a safeguard against the kind of childhood she suffered. On the other hand, she also saw it as her greatest achievement that I was free from that baggage and I have a feeling that, if I’d come to her with my plans that fall, she would have decided there and then that having a child alone, or in the context of an unconventional relationship, was the most brilliant thing any woman had done in world history. A few days after I get back to New York, my dad calls me at my desk in Brooklyn. “I’ve discussed it with Marion and we’ll support you in whatever you do,” he says.
CHOOSING A FERTILITY doctor is not like choosing a knee surgeon. If it was, you might simply browse a dozen clinic Web sites and pick the one with the highest success rate. Instead, when you meet a fertility doctor for the first time, you find yourself making all sorts of unscientific judgments. Do I like you? Do I approve of you? Do I want you to play a role in the story I tell about my kid’s creation? Are we on the same wavelength so that my body doesn’t go into spasms of dislike whenever it sees you and resists the tasks it is being asked to perform? All nonsense of course, otherwise no children would be conceived in bad relationships, but there you are. The dreadful woo-woo bullshit around fertility begins here.
“So how can I help you?” says the doctor. She is the first on my list, an ob-gyn with an office in Midtown who has come to me recommended by friends. I sit before her, legs crossed at the ankle, feeling like I’m on a first date and trying to revive my spirits after the experience of the waiting room, a tiny windowless space with an ornamental fountain that tinkled away like something designed to soothe the unnerved. The only other woman present was in an iron-gray suit and had very tightly curled hair. It described the atmosphere perfectly.
The doctor is in her late thirties, with big, sad eyes and an air of almost lascivious sympathy. Not my kind of doctor at all. In New York, my favorite doctor is Dr. Dolphin, my eye guy, who, sliding a needle into my lower lid one time, said, “Who’s having more fun than you right now?! OK, heel to the steel!” (In the UK, my favorite doctor is the bluff, middle-aged woman GP who told me I did not, in fact, have stomach cancer, but had for years been wearing my jeans too tight.) This woman looks as if she were about to cry, and to overcome her piety, I crank my jocularity so high I sound like a seventies game show host. “Want to have a baby! . . . About to turn thirty-eight! . . . In a relationship but taking full moral and financial responsibility!”
She nods, unfazed by any of this, and after asking me a few general questions suggests we adjourn to the treatment room next door for the ultrasound. “Out of interest,” I ask, gathering my things, “how old is the oldest client on your books?”
“Forty-seven,” she says and adds quietly, “It’s too old.” I am so surprised by this candor that I feel myself warm to her, before realizing what I’m actually experiencing is a mean-spirited high from not being considered the worst-case scenario.
No one has ever looked at my ovaries before. No one has ever looked at my kidneys before, either, but kidneys are different, and as I climb onto the gurney, I find myself worrying about them on the basis that women worry about every other part of their anatomies: not that the doctor will discover something medically amiss, but that she’ll hit upon some hitherto unrevealed ugliness. They could be misshapen, or asymmetrical or in the wrong place. They could be completely vacant, like one of those trick gift boxes that are empty save for a Christmas cracker–style joke. Perhaps all these years I’ve been sailing along thinking myself anatomically normal when, all the time, some twisted anomaly has been lurking within.
“Here,” she says neutrally, and points to several dark patches. “Fibroids.”
“OK.”
She skims around a bit more, seeing things I can’t see, then abruptly switches off the machine. “Very common, nothing to worry about, although we would keep an eye on them for growth.”
This is the first and most superficial of a battery of tests that need to be done before treatment can start. My ovaries may look OK on the screen, but it remains to be seen if they’re actually working, and to move on, says the doctor, there are more preliminaries—not, as in England, discussions about my emotions or lifestyle, but concerning something much more important: money. That is the real precursor to receiving medical treatment in the United States, and after the ultrasound, she ushers me through the waiting room into the office, for a meeting with someone far more significant than she is—the clinic manager—to talk about fee structure and financing.
Insurance anxiety is such a big part of this story it is worth pausing here to describe the lay of the land. My policy, which is administered in England and is available only to British nationals living abroad, is, with one very large caveat, absurdly generous by American standards. For the same price as the most punitive and exemption-ridden American policy, I have no deductibles, a co-pay of forty dollars per visit and, as far as I can tell from glancing at the small print, more or less limitless disbursements, so that in the years since moving to the United States, I have hammered it so mercilessly—endless checkups (it doesn’t cover checkups, but every doctor I’ve been to has supplied the fake codes); multiple trips to Dr. Dolphin for recurring blocked tear ducts; an expensive biopsy on a lump of gristle in my right breast that a British doctor had deemed, on the basis of a manual exam, entirely harmless and that of course after thousands of dollars’ worth of exploratory tests in New York, turned out to be so—that my dad jokes about selling his shares before I bankrupt the company.
A few days before my trip to the doctor, I had called my insurer’s hotline in England, to see if they would cover my treatment.
“So, your husband—” said the operator. There was a pause, during which I could hear her belatedly engaging with the requirements of EU discrimination law. “In order to qualify for fertility treatment, your partner must also be a policy holder of at least two years’ standing.” Damn. Gender-neutral language. I had been all ready to bring up L and frighten them into approving me.
“What if there isn’t one?” I said.
“I’m sorry?”
“What if I’m having a baby alone?”
“I . . .”
Static over the Atlantic. I felt sorry for her then; she was probably twenty-four years old and sitting in a cubicle in a business park in Slough.
“That wouldn’t be covered by the terms of your policy,” she said eventually.
“Can I ask why not?”
“I . . . it . . . I would have to . . .”
I could fight this. But the truth is, I don’t really see why my insurers should pay for it. I understand that if the policy covers one type of person for treatment but not another, judgments are being made about who is deserving. And if they were denying me coverage on the basis of my sexuality, I would make all the necessary complaints. But either through moral cowardice or preemptive exhaustion at the thought of waging a futile battle, I have a tough time seeing “single woman” as a category that, in this instance, deserves equal protection under law. After all—and I have never articulated this to myself quite as clearly as I do in that moment—it isn’t very respectable. It’s selfish. I’m selfish. No more selfish than anyone else wanting a baby, but to make a lifestyle choice that deviates so spectacularly from the norm and then expect other people to pay for it seems to me to be a bit bloody much. I get off the phone with a breezy “no problem,” as if my inquiry had been entirely hypothetical, and think, maybe it’s better this way. If it is going to be hard, let it be hard from the outset so I have time to muscle up and adjust. Insurance be damned, I’ll pay for it myself.
The truth is I’m not yet worried about the cost of all this. I’m almost forty. I have a lot of savings. I’ve never spent more than I earn. I own property in one of the most valuable markets in the world. I think of all this, rather vainly, as being “sensible about money,” although it has more to do with having (in English terms) a middle-class background, with all the safety nets and security that brings. A lot of outlandish things would have to happen—having more than one baby, say, or the economics of the entire news media falling into a hole or Britain’s deciding to leave the EU, wiping a third of the value off sterling, none of which, obviously, is going to happen—before my assets start to dwindle. Looking ahead, I even relish the prospect of a little financial pain; it will reboot my ambition, I think, make me hungry again, less sour about interviewing actors. Besides, how expensive can one tiny baby be?
The worst I can see, out of the corner of one eye, is the terrifying cost of IVF, which seems to go up in increments of fifteen thousand dollars and which, above the age of about forty-two, I once heard described by a doctor as “throwing money into a pit.” At thirty-seven, however—which, in what might be the single attractive thing about the fertility industry, I’m learning can be stated as “only thirty-seven”—there is nothing to suggest I need IVF. What I need is IUI, intrauterine insemination, a medicalized version of the turkey baster in which the sperm is launched, via catheter, high up into the womb, minimizing the distance it has to travel to meet the egg. It’s cheaper than IVF and much less invasive, requiring in the first instance neither injections nor general anesthetic. That is the good news. The bad news is that for IUI, the broad-stroke success rate for women my age is roughly 12 percent per cycle.
I know this only by accident. One of the things I can never figure out is how, in the face of big life choices, one draws the line between finding out enough to make an informed decision and finding out so much you can’t make a decision at all. My approach, so far—except on those occasions when I have failed to shut down a Web site quickly enough—has been denial. From the outset, I decided the only way to proceed without becoming paralyzed by fear was to limit my thinking to a tiny, immediate-term time frame. It’s like the thing E. L. Doctorow said in every interview he gave, including to me; that writing a novel was like driving a car down a dark road at night—he couldn’t see beyond the arc of the headlights, nonetheless they guided him home. I won’t think about money yet, or living arrangements or relationship status. I won’t think about the fact I don’t have a green card or that my dad lives three thousand miles away. All I need to get home is hope and a measure of ignorance.
The clinic director doesn’t mention the 12 percent success rate. To listen to her, you would think no woman over thirty-five has ever had trouble conceiving, and as she talks, I become aware that for my own denial to be sustainable, I must be sure that everyone else in the chain is operating fully in accordance with reality. Patient denial is an act of psychological defense; doctor denial is scalping.
“Here,” says the director and hands me a glossy brochure advertising the clinic’s special deal—three rounds of IUI for the cost of two, not including drugs, blood tests or unforeseen complications. It’s five thousand dollars for the package and if I want, she says, I can pay in installments.
“OK?” she says.
This is not a good moment vis-à-vis my newfound enthusiasm for American health care, but I meekly reply, “Yes.” Then I go home and freak out.
How on earth can one buy medical treatment the same way one buys three-for-two cans of beans at Costco? What if, after the second round of IUI, the prognosis looks so grim that any sensible doctor—that is, one not bound by a bulk sales agreement—would recommend a move to IVF? What if I get pregnant on the first round? Doesn’t this approach guarantee that, at some level, the doctor’s decisions will be based on commercial, not clinical, considerations? If a clinic thinks bulk sales are a good idea, mightn’t they think ordering tests I don’t need or performing unnecessary procedures are equally good ways to make money?
It reminds me of those dentists who try to push Botox on you while they’re flossing your teeth and, sure enough, a day or two later, the hard sell continues with an e-mail not from the doctor but from the clinic manager asking me to “review the financial portion” of my visit and repeating the benefits of buying a “multiple package.” Also, she says, because I intend to use donor sperm, I should be aware that the clinic charges three further fees: a $200 handling fee “for all cryopreserved materials,” a $100 fee for “thawing the sperm” and a $500 storage fee, should I wish the clinic to hang on to any unused sperm. I send back a polite note saying I have a lot to think about and will be in touch at some point in the future. Two years later, I’m still receiving their newsletter.
“AMAZING,” SAYS OLIVER. We are at a French bistro on the corner of Smith Street and Degraw, which is roughly halfway between his apartment and mine. (It’s nearer mine, by a whisker. Whenever we have lunch, which we do most weeks, one or other of us checks Google Maps to determine who has the longer walk to the restaurant. Today I have won by about seventy yards.) “What are you going to do?” he says.
“I don’t know. I suppose keep looking for a doctor.”
It is funny to be here having lunch as we always have, with this discussion about kids on the table. Our lives have both changed since we came to New York—Oliver has written a book and has an American girlfriend; my life is full of L and her baby; we have both acclimated to working at home after ten years in an office—but in some ways, nothing has changed. In spite of a certain surface cynicism, I think we are both still romantic about the country we moved to. Some of my notions about the United States were dispelled within the first few weeks of arriving, but the one that has stubbornly failed to die is that, with the exception of banking technology, America is a place where the future happens first. You can do anything in America. You can change who you are, or at least what you look like, so that seven years after moving, although I am still, at heart, a disheveled English person, I sit across the table from Oliver today with a better haircut, a bigger wardrobe and, after a lot of badgering from L and to the disgust of British friends, shiny white veneers on my teeth. (From a patriotic standpoint, cosmetic dentistry is to British people what burning the flag is to Americans.)
Oliver sits, as he always does, in a dark sweater with a zip up the front, buffer than he was when we lived in Britain and, I notice, with the first gray flecks at his temples. Like many thirtysomething men, he is somewhat mystified by my certainty that I want to have a baby, and can cite a handful of studies testifying to the fact that parents are slightly less happy than people without children.
“A study says . . .” I say, teasingly.
“But I’m genuinely curious. How do you know?”
“I just do. I just know that it’s right for me.”
What Oliver can see, he says, is that if one did want a child, there are advantages to doing it alone, without having to commit to another adult, notionally for life, or figure out the relationship stuff first. Having a baby is one thing; determining whether you’re on the same page as your partner about private education or TV during dinner is another order of difficulty entirely. “I can absolutely see the appeal,” he says. “Being on your own streamlines about ninety percent of the decisions.”
Single men of his age are supposed to feel like this, unsure of “settling down.” Single women are not, and every time we talk about it, the same worry yawns open: that all my rationalizations—that what I’m doing is the smart choice, the responsible choice, the choice that untethers having a child from a relationship not built to support it—are a fig leaf for something less admirable. What if, rather than boldly embracing a new kind of family, what I’m doing is standard-issue, male-type commitment phobia? What if, like my weakness for women in gold Rolexes, I am miscasting as feminist victory what is merely the aping of crass male behavior? You’d think that committing to a baby, the most binding commitment of all, would be enough to assuage this fear, but of course that is not what is meant when people talk about commitment phobia. After the birth of L’s baby, a couple of youngish guys in her office told her she’d inspired them; what a genius move, they said, to carry on being single while having a baby alone, and they sketched out for her, only half-jokingly, a scenario in which they carried on being single heterosexual guys, going out, getting drunk, dating women, having roommates, but doing the family thing, too. “You know someone has to look after the baby, right?” said L.
I know, of course, that I’m not like those guys. I don’t want to party. I don’t want to date. I don’t even want to go out; I’ve been out. I’m not waiting for something or someone better to come along. Most ludicrously of all, I am not, by some definitions, even single. I call L my “partner,” because what else can I say, but that doesn’t really cover the ground. Six months after the birth of her baby there is love, and closeness, and reciprocity and occasional hatred that can be triggered only by deep romantic involvement, but the need for separation—not just time apart, but profound, structural circuit breaks between us—is real. It is how our personalities work in combination, the distance on which not just our intimacy but our ability to like and not murder each other depends. As the years go by it becomes increasingly apparent that this is not a relationship phase. We have found our level.
Still, I worry. I hear myself sometimes describing my relationship to others and think I sound like the female half of those heterosexual couples in which the man has persuaded the woman to agree to an open marriage—the tra-la-la, it’s-so-wonderful-to-defy-convention breeziness, when you know deep down it’s a hideous mess. Not belonging to a well-defined category alarms me. I have no words for what I am to L’s baby and I have no idea what she will be to mine and this lack of a language implies something is wrong. And yet whenever I go through these loops, they always end here: with wonder, and amazement, and the most profound gratitude for L’s baby and the possibility of my own. There is doubt and anxiety, but the last word is still love.
After lunch, Oliver and I walk west toward Gowanus. We talk about staff changes at work, and the ongoing mystery of American health care. We talk about the cost of fertility treatment. When I told L about the bulk package, I half worried she’d give me the speech about everything in life being negotiable and tell me to go back and ask for a discount. In fact, she took one look at the brochure and said she thought the pricing structure was ludicrous and very obviously a scam. (I have no such worries with Oliver, who is even more English than I am and, to avoid confrontation, prefers to conduct his negotiations in writing, over many months, with someone from customer complaints.)
After bickering for a few moments about who walked the farthest to lunch, we part on the corner of Wyckoff and Bond. “Ah, Brockesy,” he says, giving me a hug, “it’s been a long, bad-tempered marriage,” and although his tone is ironic, the truth of it is that my relationship with L is enabled—subsidized, even—by the nature of my other relationships. Close friendships are supposed to be a crutch of youth, a stopgap until one’s other half comes along, but that has not been my experience and it is Oliver, just as much as L, to whom I look to explain my life back to me, just as it’s Merope I call to reassure me of the things I already know. “Good one,” she says, on the phone from London, when I tell her I am moving on with the baby thing. “Do it, do it, do it.”
DR. B’S CLINIC is on the Upper West Side, but not the posh part. (Tenth Avenue, a mile from the park, and way up in the nineties.) There is no water feature in the waiting room or soothing Muzak to move a person to rage. Instead, the TV is tuned to Matt Lauer and his chums, and when the Today show ends, the receptionist flips to TMZ. It is a month before Christmas and I am ready to commit. I am ready to commit to a fertility doctor.
A word of advice for those shopping in this area in New York; as with high-end gyms in the city, every fertility clinic you encounter, I have discovered, puts out word on the street that “Madonna used it.” Poor woman; adoption agencies probably make the same claim. But whereas I can see Madge hanging out at the Equinox gym on Sixty-seventh Street, I have a tough time putting her in this particular waiting room, with its ten-year-old sofas and faded prints of popular artworks on the walls. The clinic is liberal with the insurance it takes, so the waiting room isn’t populated with fortysomething suits but with a mixture of ages and races, dressed up and dressed down, so that to my eyes it looks as near to a normal NHS clinic as you are likely to find in Manhattan. Dr. B, a large, bluff man in middle age, fetches me from reception and we walk to his office. No big eyes, no soft voice, merely an adjustment of his tie as he takes a seat behind the desk. “Now,” he says. “What can I do for you?”
I explain my situation, rather awkwardly, I suppose, because he says, “OK, so what are you doing for . . .”
“What?”
“You’re going to need . . .”
“What?”
He gives me a helpless look. “You know you need sperm, right?”
I burst out laughing. “Yes, I know. I’m choosing a donor.”
There will, he explains, be some exploratory tests and then, all going well, we will try a cycle of IUI with no drugs. He says this with a shrug, as if to say maybe it’ll work, maybe it won’t, then pulls out a chart from his desk drawer, correlating historical birth rates with the age of the mother. There is a big spike at the end, accounting for modern women having babies later and later and which, he says, “evolution hasn’t caught up with yet.” He smiles broadly. “But let’s see what we can do!”
For the next ten minutes, we chat about other things: my job, the state of the world, our tastes in TV, books and movies. The conversation flows naturally, but it also feels like a discreet but formal phase of the interview designed to ensure that I find him simpatico. And I do. I like him, right up to the point when he learns I work for the Guardian and gets very animated about Julian Assange.
Something has happened to the Guardian since I moved to New York. When I arrived, it was an office of four people in a building in Midtown, with a communal bathroom down the hall and a children’s talent agency next door, so that every morning the elevator was full of Baby Junes doing high kicks. No one would return my calls, and if they did, by some miracle, they would invariably start the conversation with “Is that the Manchester Guardian?”
“It was called that fifty years ago, now it’s just the Guardian.”
After a long pause: “I’m sorry, I don’t deal with foreign press.”
All that changed after WikiLeaks. Now it’s a loft in SoHo, one hundred people strong, and New York is crawling with former colleagues from London. There are so many of them in my neighborhood, a section of the deli on the corner has been opened up to British confectionary (Curly Wurlys, Aeros, a few dusty Lion bars). Oliver and I grumble about this—what was the point of moving when the entire office moved with us?—but it is of course deeply gratifying and I take as much passive credit for WikiLeaks and, later, Edward Snowden as I can, although I had as much to do with them as Cindy Adams did with Watergate.
Dr. B gives a short, rousing speech in praise of Julian Assange, whom he depicts as a folk hero ill served by the media generally and my newspaper in particular.
“He’s kind of a weirdo,” I say.
“Of course he is! No one else would take on interests that powerful.” Then he itemizes all the things big government isn’t telling us.
“I can’t tell if you’re on the right or the left.”
Dr. B looks indignant. “Neither. I don’t believe in those categories.”
“Oh, god, you’re not a Libertarian, are you?”
He smiles and raises his eyebrows, which I take to be an invitation not to take him too seriously. “I describe myself as an anarcho-capitalist.”
We don’t get around to money until the very end of the interview. It is nine hundred dollars per insemination, plus the cost of drugs, blood tests and ultrasounds, and I will pay only for what I need. Without insurance coverage, says Dr. B, it can get expensive very quickly and he will work with me to keep the costs down. Perhaps this is a sales pitch, too, but it works. Instinctively, I trust him.
Then he says something that shocks me. “Do you believe in god?”
I am so taken aback I laugh. “No. I mean, no. Not for the purposes of this conversation.”
“I assumed you wouldn’t.” He looks embarrassed. “But I have to ask, because if you do, there are parts of this process you might find . . . problematic.”
“Don’t worry. I don’t think you’re assisting me in going to hell.”
“OK!” He gets up, skirts the desk and, showing me to the door, offers a hand to shake. “Very good, very nice to meet you and I’ll see you next week.”
The second I get outside, I call Oliver. “Would you let someone who thinks Julian Assange is a hero rummage around in your ovaries?” I ask.
“Um,” says Oliver. “I mean, the two things aren’t really related, are they?”
“No. Although there’s a broad question of judgment.”
“Did you like him apart from that?”
“Oh, I’m not sure I disliked him for it. If anything, I liked him more for the fact he’s not an establishment drone.”
“I wouldn’t worry about it, then.”
“I mean, he’s wrong about Assange, but . . .”
“Yeah. As long as he knows what he’s doing with your . . .”
“Yeah. Right. OK. Good.”
ONE OF THE THINGS you have to get used to when you are a British person embarking on fertility treatment in the United States is the pace of it all. In a small country like Britain, the law of supply and demand is such that there are more women wanting donor sperm than there are donors to give it, so that even in the private clinics there’s often a waiting list. In America, where no one with adequate resources waits for anything, you have a chat with your doctor, schedule a date, call the donor bank, which bikes the sperm round to the clinic, and off you go. You might have spent six months or six years deciding to do this; but you could, potentially, be pregnant within a month of first seeing your doctor.
I do not anticipate this will happen to me—getting pregnant without a struggle still seems too outlandish, too decisively female, to fit the rest of my life. But the very fact that it might, or that it might be revealed to be conclusively impossible, makes the week before the last diagnostic test feel like the pause at the top of a roller coaster. If I want to avoid the possibility of total destruction, now is the time to get out. As of this moment, I’m a thirty-eight-year-old woman who wants but doesn’t have children, a sad state but that’s life, what can you do, maybe next year. If I let this go further, through diagnostic testing and beyond, I will potentially be a thirty-eight-, thirty-nine-, forty-plus-year-old woman who is trying and failing to have children, which sounds to me like a different order of upset altogether. It’s not just the fear that the treatment might fail. It’s the fear that it might fail over months and years and still end in nothing. It’s the fear that my standard damage limitation response—“maybe I wasn’t that bothered in the first place”—will be impossible to pull off. If Dr. B discovers something catastrophic when he examines my fallopian tubes next week, a whole new schedule of adjustment begins. I will have to grieve for the biological child I can’t have and reconfigure what my next decade might look like. I will have to deal with my animosity toward people with children. There will be the sheer bloody hassle of having to accommodate new facts about myself, at an age when I’m inclined to think I have it somewhat worked out. Ovaries that don’t work shouldn’t impact a woman’s fundamental identity, but I have a feeling they do, so that the choice, at this stage, seems to be between two negative self-images: that of a woman trying and failing to conceive and that of a woman too scared even to try.
And then there is L. I can’t begin to guess how infertility might affect our relationship. But given my bottomless capacity for resentment, I assume it won’t be for the better. Suddenly, I understand why women my age who want children nonetheless let the years slide by. Better to wake up one day and, without having made an active decision, realize it is over and the option to conceive has expired. In this scenario, it’s not that you “couldn’t have children” but that you “didn’t have children,” a presentation of the facts relieved of its diagnostic burden. The self-help industry assures us it’s always better to try and fail than to not try at all, but in the case of women’s fertility, there is a strong rationale for avoiding “failure” at all costs, given the way in which that failure is perceived.
For the rest of the week, I distract myself with business as usual. I meet Oliver for lunch (a Vietnamese sandwich shop in Park Slope, a decisive win on his part). I research a piece about people who die unexpectedly on airplanes, tracking down a Swedish woman who tells me what it was like to sit next to a corpse for nine hours on a full flight from Sweden to Kenya. On the weekend, I go to Costco with L and the baby. As we cruise the overlit aisles, trying samples and reliving our greatest Costco hits—this was where we bought the crab paste that got recalled; here, the site of our most legendary impulse purchase, a machine that vacuum packs meat—I try to imagine another child in the cart, this one with my face on it. Will we look like a family? I wonder. Or like two disparate people and some babies who’ve teamed up to buy bulk?
I am not supposed to shrink from describing what happens next. I should be proud to reclaim the language of female anatomy. Unfortunately, while it strikes me that “testicle” can raise a titter and “penis” can be kind of fun, and that post–Eve Ensler even “vagina” is less burdensome than it was, once you get into the realm of hard-core female reproductive machinery—FALLOPIAN, OVARY, CERVIX, UTERUS—I find it very hard not to feel that I’m letting the side down. Womb. Glands. Tubes. Eggs. If I could write about my experiences while avoiding these words, I would. In the event, all I can do is apologize to anyone who finds this kind of thing as distasteful as I do and recommend skipping ahead to chapter 8, where there is blood, yes, but also some lovely Vancouver scenery and a walk-on appearance by Al Gore.
For those still with me: here is Dr. B, at the foot of the gurney, firing a tiny jet from a water cannon around my fallopian tubes while following its progress on the ultrasound. “Look,” he says, pointing at the screen, a black expanse streaked with silver. It looks like a shit version of Space Invaders.
“Hmmm,” I say, as if we were standing before a painting in a gallery.
We wait. And wait.
“I’m not seeing any movement through the fallopian tubes,” says Dr. B. “Hang on.” He adjusts the tube and points to the screen. “See? This is where the water is going in and . . . nothing is coming out the other end.”
I frown as if making intelligent sense of this, although the truth is medical details hit my brain like street directions; if I’m lucky, I can grab hold of a single orientating term to feed into the Internet afterward. Otherwise, I go on the mood of the room. This one isn’t good.
The absorption of bad news can be forestalled by the more pressing task of dealing with the feelings of the person who’s giving it. For about twenty seconds after we got my mother’s terminal cancer diagnosis, she and I looked at the mustachioed oncologist and thought, my god, this poor man is in agony. One imagines that a death sentence will unleash violent emotions, or perhaps paralysis. What one doesn’t anticipate is the embarrassment. As Dr. B stares at the screen, I feel the weight of his discomfort more keenly than the findings.
“No,” he says eventually, looking a little cross. “Nothing’s coming through the other end. OK, we have a problem.” I get dressed and, after a short wait, adjourn to his office, where he prints out a screenshot of my fallopian tubes and places it on the desk between us. It looks like grainy satellite imagery of enemy ground the U.S. Air Force is preparing to bomb.
“OK, there are some options,” says Dr. B. The hydrosonogram is not a foolproof procedure and sometimes produces false negatives. Maybe nothing is wrong and we should start the treatment regardless. On the other hand, he says, maybe the test is right and I have blocked fallopian tubes, in which case there’s no way I’ll get pregnant without intervention—at the very least, an operation called a hysteroscopy, in which a tiny endoscopic camera will be threaded into my uterus, so the doctor can identify the problem and potentially fix it. It could be fibroids, it could be nothing, it could be something. My call. I am, after all, the paying customer.
I wish I could say that after this consultation, I suspend my moratorium on research and self-educate to Ph.D. standard, like Nick Nolte in Lorenzo’s Oil. At the very least, I should be feverishly Googling “hysteroscopy” and its related terms. But every time I think about researching the operation, I am overcome with inertia and something else, a primitive sense that by focusing on the bad things I will increase the chances of them happening. The most I can bring myself to do is to Google “blocked fallopian tubes,” a search that brings up a lot of testimony from desperately unhappy women at the tail end of multiyear fights to get pregnant. Blocked tubes, I read, account for some 20 percent of infertility.
And yet I’m reluctant to go in for elective surgery. The operation, said Dr. B, can be conducted only under general anesthetic and taking even the tiny risks associated with that seems obscene. My mind ranges back to the chemo unit. Bravery in the face of cancer is admirable; bravery in the face of an avoidable operation feels like a parody of those with real problems.
I do something then that is more emotional than practical: I look to see how doctors would be handling my situation if I still lived in Britain. If the hysteroscopy is considered all right at home, under a health-care system so strapped for cash that most NHS managers would rather die than green-light an “unnecessary procedure,” then I tell myself I have nothing to worry about. If the Brits don’t go for it, then neither will I.
It takes two minutes at my computer to find what I’m looking for: guidelines issued to doctors by the Royal College of Obstetricians and Gynaecologists. Just reading those words soothes me. Here we go, the royal standard, the firm hand of authority from a world-class health system that doesn’t ask you, the least qualified person in the room, to make clinical decisions, but instead tells you what’s good for you and you can either like it or move to America.
The advice laid down to British doctors by the RCOG is that the hysteroscopy is a “successful, safe and well-tolerated” operation, albeit one associated with “significant pain, anxiety and embarrassment” on the part of the woman. In spite of that last bit, the governing body recommends that doctors conduct it under local anesthetic, because, to paraphrase, buck up ladies, that’s life. (One wonders if it was a man or a woman who wrote these guidelines.) It is hard not to laugh at this, the difference in the two cultures’ ideas of pain management. In Britain, whether it hurts or not, it is assumed you will take it on the chin and be grateful that anyone bothered with you in the first place. Years before moving to America, I’d gone for minor eye surgery at Moorfields in London, and when I inquired, timorously, of the consultant, “Is it going to hurt?” he gave me a flat yes and a spiky look just for asking.
In America, by contrast, any degree of pain, like any degree of heat or cold in a poorly temperature-controlled house, is considered less a fact of life than a failure on the part of the service provider. In my biased view, this makes pain as a concept harder to control, although this is, I understand, as much a hangover from my mother’s parenting as a function of cultural difference. In the chemo unit, at home with her back pain, throughout her entire life, it was my mother’s core belief that something will hurt in proportion to the fuss that one makes about it. As a result, in very limited circumstances—blood tests, immunizations, minor operations—I can enjoy pain; it makes me feel important. My eye operation hurt like hell, but it gave me something to kick against and allowed me to congratulate myself for being my mother’s brave little soldier.
After reading the RCOG guidelines I decide I’ll have the operation. But bristling with my mother’s machismo and something like patriotic pride, I call the clinic to request it under local anesthetic. Twenty minutes later the nurse calls back and says under no circumstances will Dr. B operate without a general anesthetic and doubts any doctor in Manhattan will; it is simply too painful.
Something occurs to me then. If I had been with a male partner trying to conceive the regular way, I would in all likelihood have been trying and failing to get pregnant for months or even years by now, my two blocked tubes undiagnosed and untreated. I would, potentially, already have become That Woman, whose inability to conceive overshadows every other aspect of her life. By doing it the artificial way, I have shrunk the agony down to less than a week. Fear gives way to relief and then to euphoria. A third self-image presents itself: I am immensely lucky! This is all for the best! Thank god I’m half single, half in a same-sex relationship and not in a conventional marriage! Four days later, I go in for the procedure.
L has a meeting that morning and offers to cancel and come with me, but it gives me a small sense of victory to renounce my own needs and so I turn her down, then get the added buzz of resenting her for not overriding me. (She knows I am doing this, and won’t override me partly in retaliation for not stating my needs plainly. I tell myself this is completely unjust given that we can’t change our natures and there’s a minuscule chance I might DIE here.) Oliver, with whom I do not play these games, travels up from Park Slope for an eight a.m. start and sits with me in the prep room, where he spends thirty minutes trying to get Wi-Fi and communicate to the anesthetist that he isn’t my husband—unsuccessfully on both counts. Just before I’m wheeled in, my phone buzzes; it’s L, texting me a photo from the summer of me holding the baby in an orchard. We are both smiling at the camera. I send her back kisses.
When I wake up, Oliver is at my bedside. “You’re not making any sense,” he says.
“Huh?”
“You’re talking an amazing amount of shit.”
I still occasionally worry about this. Given that I emigrated on the strength of the drugs for three fillings, I can’t imagine what unfiltered junk flew out from my subconscious after being out cold. With Oliver’s help, I get off the gurney and, after retreating behind a screen to get dressed and thanking the anesthetist—“Good luck to you both,” he says, and we blush—we make our way upstairs to reception. Depending on what Dr. B found down those tunnels—space debris? Scar tissue? Cobwebs?—it is possible I am about to hit the end of the road, in which case, I decide, I will simply push it to the back of my mind along with all the other things I put off indefinitely, like figuring out what I think about life after death and finding an alternative to Time Warner Cable. Eventually, I have to believe, I’ll come to terms with it.
Dr. B appears and beckons me to follow him into his office.
“A buildup of matter,” he says genially. “Quite normal, very common and I’ve cleared both tubes out.”
“What kind of matter? What’s it made of?” He says some words I don’t catch—some sort of tissue, possibly beginning with F. Anyway, “Water is flowing in both directions,” he says. “We’re good to go.”
This is great news. There are no further preliminaries. I gulp; now I will actually have to go through with it.