As the days grew warmer, I still mourned the loss of my soured dreams. Once again I turned to my husband with hopes of renewing our well-rehearsed debate on having more children. Jon was worried. He was worried about me, the turbulent months of my pregnancy with the twins, and the potential toll another pregnancy could take on our content and stable family. He hated the thought of more shots, more stress, and more doctor visits. Above all else, Jon worried about the possibility of having twins again.
However, I sensed a crack in his armor. He was softening. He knew only one thing in this world would fill the aching void I felt, and that one thing was downy soft, sweet smelling (most of the time), and had the power to light up the whole room with one toothless grin.
Finally, he agreed to go through it all again—just one more time for three more cycles, a total time commitment of six months. I screeched, dove for the phone, and made an appointment with an infertility specialist right in Wyomissing, just minutes from our home. With my first pregnancy, I had driven an hour away to Allentown, Pennsylvania. Although I obviously had success with that doctor, I felt the convenience of seeing a respected doctor in our own town made much sense, especially with two busy two-year-olds at home.
My first cycle was all that I had remembered—painful injections to help me ovulate, consequent hormonal upheaval, frequent doctor visits, and finally, ultrasounds. I kept my eye on the goal, withstanding it all in the hopes of once again being blessed with the good fortune of holding the much-awaited prize.
To take my mind off some of this all-consuming process, I decided that it would be the ideal time to treat Mady and Cara, who were soon to turn three, to every little girl's dream: Disney World. As with every project I take on, I became obsessed with our family vacation being one of those memories to last a lifetime. With great gusto, I researched every single thing that Disney offered, from sharing breakfast with Cinderella in her exquisite castle to the best time of day to go on the Dumbo ride. Our trip would culminate with a relaxing visit to Jon's aunt and uncle's quaint and quiet cottage for a much-needed detox period from a certain merry mouse and all his inherent chaos.
Jon couldn't grasp my urgency in taking a vacation during such a potentially volatile time on our journey to get pregnant. I, on the other hand, had high hopes of our lives becoming considerably busier in the upcoming year. I felt as if I desperately needed to give this important gift to our curious giggly girls, because, after all, it could be years before we might have the chance to take such a vacation after another baby arrived.
We found out a short time before we left for Florida that my first cycle of treatment was not successful; consequently, I spent one of the best vacations of my life reeling from the rapid surge and then immediate dip in hormones. Nevertheless, although disappointed, I couldn't wipe the giddy smile off my face as I watched our two joyful balls of energy squeal with sheer bliss as we rode the monorail into the park and shook Mickey's white-gloved hand.
We later sat on the white sand beaches bordering our relatives' home contentedly reading, watching Mady and Cara dig in the shimmering warm sand, and soaking up the much-needed quiet. Even now on my worst days, when anarchy rules, I get teary-eyed remembering the simplicity and easygoing pleasures of that smooth and peaceful and truly once-in-a-lifetime vacation.
September was our month of rest in between infertility treatments. It is a necessary reprieve which the body, and I believe the mind also, requires to regain some degree of internal balance before once again enduring the onslaught of hope-filled injections.
Before we knew it, October arrived, bringing with it cool crisp days and the brilliant shades of autumn. I felt an odd calmness descend in my spirit as I watched the girls romping and laughing in the newly fallen crunchy leaves of the backyard. I knew with everything in me that this was the month. This would be the month that we would finally get some positive news.
I couldn't shake the memory either of my dear, sweet, and oh-so-intuitive Mady who, at just shy of three years old, had made a declaration to me with all the soothing surety of a Sunday morning preacher. I had been resting on the couch a short time before leaving for vacation, crying and lamenting over the news that our initial efforts had been in vain.
She came upstairs from her playroom and asked me, "Mommy, why are you crying? Is it about a baby sister or brother?" That wasn't so unusual because, even at their tender young age, I'm sure both Mady and Cara had picked up on the fact that both Mommy and Daddy had discussions involving babies quite often. But then she gently and lovingly caressed my leg with her cottony smooth toddler hand and crooned, "It'll be soon. It'll be soon."
Chills literally scurried up to the top of my head. It was as if God had sent a mighty angel in pint-sized pajamas to whisper reassurance when I needed it the most. I grasped that encouragement, tucked it deep in my heart, and stood on it firmly with all the confidence of an Olympic diver on the highest and scariest platform, about to take the plunge.
Just weeks later, Jon and I sat in a cheerfully decorated office anxiously awaiting the results of my latest set of injections. To our immense relief, our doctor happily reported that by all indications, it was a great cycle. We spent a few moments going over our next steps in the process, which initially would be an ultrasound to determine exactly how many mature follicles had developed.
As at every single meeting, Jon and I expressed on the one hand our serious reservations about the possibility of multiples, and on the other hand our desire for the doctor to fully understand our unwavering position on selective reduction. Selective reduction, in my opinion, is the politically correct term for the process by which a fetus is injected with a lethal dose of potassium chloride, which mercilessly silences forever the rhythmic beats of its tiny heart. Jon and I believe that every life, whether seconds old after conception or a full forty-week term, robustly healthy or horribly sick, fully developed or severely challenged—every life is designed and ordained from God. We would therefore never consider choosing to end that life in any way at any time. Period.
At the scheduled ultrasound on a sunny Sunday morning, the doctor was thrilled. He discovered three mature follicles and possibly even a fourth follicle with the potential to still mature. While Jon and I had that night-before-Christmas kind of anticipation, we were still concerned that all four follicles would somehow be fertilized. Up until that point, when we spoke of multiples, we basically had been referring to the possibility of twins. That was what we had experienced, and so that was our reality. Never did we ever really allow our minds to fully wrap around the idea of multiples turning into more than twins. As if reading our thoughts, our doctor was quick to reassure us that statistically it would be very unlikely that all four or even three of the follicles would be fertilized. He also was completely thorough in giving us an escape route if we so chose. We could simply discontinue the injections and repeat the process in two months, aiming for enough but not too many follicles.
During the car ride home, I silently revisited the deep conversations Jon and I had had before ever setting foot in that doctor's office. We had analyzed the what-if's: What if it was twins? Well, we thought, we did it once; it was certainly doable again. It would mean our family would be definitely complete, doubly blessed. I put a check on the yes side of my mental list.
What if it was triplets? Hmmm. That got a bit tougher. However, as we thought over practical things, like enough room in the house and finances, we decided that although it would certainly be more than we planned, we wanted children, loved children, and would willingly and gratefully accept whatever God handed us. So after a thorough heart search, check again.
That brought us to quads. We tentatively tiptoed into this territory, as if by being quiet enough, we might avoid waking the sleeping giant. Was it really worth dissecting every aspect of this unlikely "giant" if the reality was that we had almost a better chance of being struck by lightning?
Millions of thoughts kept running through my mind, but both Jon and I had an underlying peace even at that early point. We were united in our decision to proceed with that cycle. Even as we walked to the car following the appointment that day, I will never forget Jon's words as he turned to me with complete conviction and said, "We will never regret having too many children. Let's do it!" I let out a deep sigh and felt peace wash over me.
Little did I know at the time that we would be treading on holy ground, and I would need the peace of God to sustain my very life as He walked me through the minefield of surprises that lay ahead. We had carefully weighed all our odds and fearfully yet happily decided to step out in faith and take advantage of my great cycle.
I was given the one final injection of human chorionic gonadotropin, commonly referred to simply as HCG, which was soon followed by the momentous culmination of the whole long involved process: the intrauterine insemination.
No romantic dinner, long-stemmed roses, smooth wine, or flickering candlelight preceded this event. Instead it was a date with a cold sterile room, bright overhead lights, and awkward stirrups. It didn't matter. Nothing could dampen our spirits because we knew that science and humans had given their best efforts, and now the results ultimately lay in God's hands. It was as if we had just run a grueling relay race, the baton had been passed, and the finish line was finally in our sight. As I lay there looking at the ceiling, I prayed, "Please, Lord, let me get pregnant."
A little less than two weeks passed, and on Friday, November 8, I stood at work in a bustling operating room during a routine cesarean section. I had arrived at the hospital a few hours earlier, once again brandishing a white test stick that undeniably displayed the faintest blush of early pregnancy.
My heart was of course skipping in gratitude, but my body felt weak, bloated, and uncomfortable. In a lot of pain and feeling worse by the hour, I actually feared I might collapse at one point during the short surgery while I tried to stay focused on my patient and her newborn baby. Working around women in all stages of discomfort, and some who are enduring flat-out agony, somehow diminishes timid complaints of a bloated and painful belly. I managed to finish my shift and gratefully collapsed into my waiting bed when I returned home.
During a fitful night, I grew increasingly uncomfortable, and as the dark hours crawled by, the pain became a hot scream tearing at my abdomen. I awoke the next morning gasping in pain with a worried Jon begging me to please go to the hospital. Neither one of us at that point even vaguely considered that this pain could possibly be related in any way to the fertility treatments I had received just a few weeks beforehand. Even if it had occurred to us, a hospital visit was most definitely not in my plans that day. My youngest sister, Rissa, was getting married. This was Saturday, her special day, and I did not want to miss it.
I stoically but stupidly gritted my teeth and bore it, though I sat ashen-faced and quiet throughout the entire celebration. My family of course plainly saw that I was in significant discomfort and, after much convincing, I finally agreed to leave the festivities early and was at home tucked into bed by 9:30 p.m.
My hopes of sleeping were completely abandoned by midnight. I was manic with pain. My belly was by that time huge and puffy, and excruciating agony consumed me. I desperately agreed it was time to go the hospital as Jon called his father to come stay with the girls.
I was helped onto a gurney at the hospital, but unfortunately, due to an onslaught of incoming patients, I waited endlessly in the hallway. My stomach looked and felt as if it might explode. Jon frantically tried to explain to the attending doctor that my normally flat belly was now grotesquely distended. Consequently, after enduring an exhaustive exam, I was told a general surgeon would be called into the hospital for consultation, and it was likely they would be prepping me for exploratory surgery very shortly.
As I drifted in and out of consciousness, comforted little by a dose of morphine, Jon was left to answer rapid-fire questions in the doctor's quest to alleviate the source of my agony. Finally it was decided that I should first have an ultrasound done, and all I remember is hearing the OB/GYN resident whisper repeatedly, "Oh my . . . oh my . . ." Even in my delirious haze, I could tell from the look on the faces surrounding me that something was wrong, very wrong.
The doctor eventually explained that my stomach was completely filled with fluid due to overstimulated ovaries. My ovaries had actually blown up to approximately the size of an average newborn's head! The extreme pain was due to my ovaries rubbing against my other now crowded organs. This condition is only evident in approximately 2 percent of women undergoing similar infertility treatment.
Great, I thought sarcastically, I managed to beat the odds. Miserably weak and sick, I was grateful for the numbing effects of the drugs as the doctor performed paracentesis, a procedure resembling an amniocentesis, which quickly yielded two and a half liters of fluid from my abdomen. Severely exhausted and dehydrated, I spent the next several days in bed recovering from my traumatic experience, first in the hospital and later at home.
On Sunday, while still at the hospital, the doctors, knowing I had had a positive pregnancy test, routinely checked my HCG level. Normally a woman will receive a positive pregnancy result when her HCG level is 25 or higher. That number is then expected to double approximately every thirty hours until about eight weeks after the last menstrual cycle, when it finally levels off. My HCG level was at 200, and it was still one day before I should have gotten my period. By Tuesday, just one day late, that number jumped to 900.
Considering that the normal range is extremely large, no one had mentioned yet that I could possibly be carrying more than one baby. I, however, just knew. I had carried twins before. That in itself did not make me an expert. It was something deeper. Call it mother's intuition or the voice of God. Whatever it was, I just knew that my body, mind, and soul buzzed with the anticipation of something major about to take place.
Jon, on the other hand, ever the optimist, said, "I think it's only one, Kate. Don't jump to any conclusions this early."
On the Friday before Thanksgiving of 2003, I saw my infertility specialist and was reminded as I walked through the front doors how science can only do so much; the rest lies in the sovereign plans of an almighty God. That thought rang in my head as the smooth wand of the ultrasound device once again rolled over my uterus. I blinked hard and then stared at the bright screen positioned slightly to my right. Instantly my mind scanned the information. I was a nurse. I had had twins. I had also experienced what seemed like hundreds of ultrasounds. There was no mistaking what I saw, yet instantly I was in a state of denial. I simply could not allow my brain to process what my eyes were telling it.
As if in a trance, we all just continued to stare, as slowly and steadily my doctor began his fateful count. One. Two. Three. Four. I started sobbing. I saw the concentration in the deep dark eyes of my African doctor as he himself tried to remain calm as the images unfolded. I turned to Jon, willing him to say it was not what it seemed. The chill of reality washed over me as I watched my husband—my best friend, cheerleader, and storehouse of strength—slowly drop to his knees at the count of five. Fear stricken and nauseous, he couldn't bear to look anymore. I really don't think anybody wanted to look anymore, but the count continued. Six. Seven. Letter G. Yes, the lifechanging fuzzy little blips were being named. They were now A, B, C, D, E, F, and G.
There was a slight upward lilt in the inflection of the doctor's voice as he tried to sound positive. I think as much for his own comfort as for mine, he went on to explain that he was able to detect a fetus in "just" four of the embryonic sacs. As Jon and I tried to catch our breath, a nurse with twenty-five years' experience turned to me and with quiet truth gently said, "Kate, in all these years, I have never seen this many sacs on an ultrasound."
At that moment I felt like lunging at her, holding my hand over her mouth, and shrieking "Take it back" like I did when I was just a kid having a fight with my brother. I didn't, of course, and couldn't because I knew her words were like a bad tasting medicine given to me for my own good. I needed to sit up and think about this harsh dose of truth.
We sat in a stunned silence, which was abruptly broken as the doctor calmly stated, "Kate, when you're done here, come into my office, and we will talk about selective reduction." As if I had been snapped with a rubber band, I grabbed the sides of the exam table and shot up onto my elbows and yelled, "We will never do that!" I felt my first fierce surge of motherly protection over my unborn babies—whether there were two, four, or even seven of them.
I was completely numb as I got dressed. I had an almost unbearable urge to lace up my sneakers and run. I just wanted to feel my heart pumping and the wind in my face as I left behind the black hole of threatening pandemonium that was spreading like a disastrous oil spill. But then it struck me, the problem would come with me. Wherever I went and whatever I did from this day forward, I knew that potentially seven innocent lives were relying on me.
With that thought and maybe a million others scurrying in my mind, I resolutely sat in the sturdy cherry wood chair of the doctor's office. He and I went head to head as he offered facts and information, statistics and grim details of how my life would be at risk. I would never be able to withstand the physical toll that this pregnancy would take. I could die. What about my two sweet little girls at home? They needed me and deserved to grow up having their mommy. The risks for my seven babies also were huge and could not be denied. Assuming that the medical field was capable of getting them to a viable gestational age, usually at least twenty-four weeks, they still stood the risk of suffering premature lungs, blindness, cerebral palsy, and mental retardation—just to name a few possibilities.
I was not swayed. Staring into Jon's eyes with determination, I asked him if he would really be able to stand before the Lord one day and admit that we had allowed our precious babies to be killed in order to make our lives easier and more convenient.
The same concerned nurse who had lovingly stood by my side during the ultrasound begged me to please stop using the word "kill." I didn't. I couldn't. To me that's exactly what it was. Tell me how I as a mother would go about "selecting" which beating heart to snuff out as if it were just a candle. Please don't think I am judging all of the women who are faced with this horrible decision. I can only answer for myself, and "as for me and my house, we will serve the Lord."
Jon, even at the risk of losing me and raising Mady and Cara on his own, unconditionally agreed with me. Who would live and who would die was not a decision that rested in our human hands.
My doctor, visibly shaken, stood and pounded his fists on his desk for emphasis. He declared that it would be a long, arduous, uphill battle that he was strongly urging me not to fight. I realized that I had become a fertility doctor's worst nightmare, and dawn was a long way off.