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Who Moved My Fallopian Tube?

It was supposed to be the no-brainer procedure of the batch of standard infertility evaluation tests, the one diagnostic test that was more formality than functional. Hysterosalpingograms test whether fallopian tubes are open or blocked, and for women trying to get pregnant and not succeeding, the immediate results of this test can make a huge difference.

In my case, no one suspected I had any problems with my tubes, but my medical team decided it was worth it to know for sure and rule it out since a lot of the time, women have blocked tubes and don’t even know it. I had enough problems we already knew about that the last thing we needed was a separate condition going undetected.

I am careful not to turn this site into an infertility blog—my goal is to explore issues surrounding living with chronic illnesses in general, rather than focus on a specific condition or topic. The thing is, though, these two topics seem to overlap more and more these days.

Tubes aside, my reproductive challenges are two-fold: there is the question of can I get pregnant and the inevitable question of should I get pregnant. The “can” part is somewhat dubious—if I don’t have cilia in my reproductive system (and there is no way to test this) then things can’t move along my fallopian tubes to get where they need to be. Other than simply trying and never getting pregnant, a high-risk specialist told me one of the only other indications of whether or not I had cilia would be an ectopic pregnancy.

Equally complicated is the “should” question—some of the numerous concerns there include increased infections and hospitalizations and further decreases in oxygenation, all of which mean a significantly increased risk of seriously pre-term delivery (and that’s just the beginning).

In the middle of these two questions are assisted reproductive techniques like IVF, and here again the can versus should debate is ever-present: were I to elect this path, I could only have single-embryo implantation because the high risks I already face mean multiple births are simply not an option, and the same high-risk factors need to be weighed.

So as we’re processing all of this information and trying to make what seem like impossible decisions, this one test was supposed to be the easy part.

“So you don’t have a left tube, correct?” the doctor asked me during the test.

“Um, as far as I know I do. I’ve never heard that I don’t,” I said.

“Well, the right one looks good but the left one isn’t here,” she said. A pause.

“Don’t get too worried, most of the time this just means the muscle is spasming and the dye can’t get through,” she continued. “At this point, I don’t think more invasive tests are necessary, but we’ll revisit that issue if we need to.”

I nodded, slightly stunned. It wasn’t so much that I didn’t believe her—and intellectually, I knew she was the expert and had seen enough of these to know—as it was that I just hadn’t planned on hearing anything other than “Just like we expected, everything’s fine.”

But after all these years, why is it that I am still surprised when my body doesn’t act the way I expect it to? It never has.

And the more I thought about that, the less inclined to worry about my currently Missing in Action fallopian tube. Things looked grim and wrought with complications, but I’d faced grim and complicated situations many times and somehow, my body always managed to do what none of us expected it to: survive.

The one thing I can say with utmost confidence about my body is that it is unpredictable and anything can happen–which is exactly why I’m not giving up on it just yet.

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As Good as It Gets? Thank You Very Much

The Wedneday night before Thanksgiving, I collapsed on the couch just in time to watch “Top Chef” with my husband. I had the day off and spent most of it preparing appetizers for the next day’s feast—in between bouts of coughing, wheezing, and assorted aches and pains. For weeks now I’ve been battling what I refer to as a “high-functioning plague,” a respiratory infection that has lodged itself in my lungs and won’t let go. While it makes breathing difficult and congestion constant, I am usually still able to go about my daily activities and am not confined to bed. I feel sick, but it is a functional sick, so it is okay.

During the commercial breaks, my husband and I chatted a bit about our upcoming few weeks. I mentioned needing to schedule a test I’d had to cancel earlier this fall, and the conversation eventually drifted towards an inevitable topic with us these days: maintaining stability. It’s been 10 months since I’ve had a seriously acute respiratory event and needed to be hospitalized, the longest stretch I’ve had in over a decade. I am so conditioned to expect critical illness that sometimes I can’t even believe it. I’ve had to juggle several other conditions, but they are more life-altering than life-threatening.

Three years ago, I spent the entire week of Thanksgiving in the hospital. I spent Christmas Eve of that year being transported by ambulance from my parents’ hometown hospital to my Boston hospital, one Christmas out of the past five I have spent in the hospital in recent years. Holidays haven’t always been especially festive for me.

But here it was, the night before Thanksgiving. My appetizers were finally ready, my condo was scrubbed clean, one of my favorite shows was on, and I wasn’t anywhere near the hospital. The holidays were indeed making a comeback.

As the night progressed, my symptoms worsened. I turned pale, got clammy and sweaty, and the exhaustion in my arms and legs was overwhelming. This was a nightly occurrence, as was the coughing jag that followed. We barely noticed it, only pausing to turn the volume on the television up more so we could still hear it above all my racket.

“It’s not great, but it’s a lot better than the past few years. I’m not healthy, but I am stable,” I said to John.

“It might just be as good as it gets. And you know what? I’ll take it.”

“Me too,” he said. “It’s more than good enough for me.

And when we sat down to dinner the next day with our family—including my father, who only a few months ago underwent heart surgery, my mother, whose joints would pay for her meal preparations for days to come but whose smile didn’t show that, and my niece, a healthy and happy two-year-old—we knew that while stable never means perfect, we’ll gratefully and thankfully take it for all of us.

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Invincibility and Illness

One evening last week, I noticed a girl doing something I would never do on that particular stretch of urban street: walking alone in the dark. Granted, it wasn’t extremely late and there were lots of cars and buses on the street. But it was a poorly lit section of road in a pretty tough area—one where a gang of children (children!), ages 10-14, had nearly stabbed a man to death around 9pm just a few weeks ago—and with lots of dark alleys and shadowy hills, it wasn’t exactly a welcoming area once the sun went down.

I could tell she was a college student: she looked about 18, she was wearing a sweatshirt with the insignia of a university just a few blocks away, she had a backpack slung over one shoulder, and like many of the students I see on my campus, she had iPod headphones in her ears and Ugg boots on her feet.

Beyond these telling details, there was something else that told me she was in college: her air of invincibility. She strolled down that dodgy, dangerous street confidently. I admired her for this, but I also worried about her on account of this.

I think it’s an almost universal experience, that sense of invincibility and fearlessness so common during the college years. We’re insistent that we can work hard and play hard; we take challenging courses as we balance campus parties and social events. We stagger home from bars late at night, usually without worrying about if this is safe. We pull all-nighters to cram for finals without considering what this does to our bodies. We eat unbalanced meals at ungodly hours, we think coffee is an equal substitute for rest, and we think because we are young, we can get away with it.

In college, I may just have been foolish enough to walk alone in a city at night. In fact, I know I did this on more than one occasion, buoyed by the false notion that because I was in a “good” area that guaranteed nothing bad could happen. But for me, this air of invincibility was even more pronounced when it came to my health. In addition to the typical age-related tendency towards taking risks, I had to contend with my innate response to the interruptions of chronic illness—the harder it pushed me, the harder I pushed back.

I over-extended myself largely to prove that I could do whatever I wanted despite being sick. I took on too many extra-curricular activities, I spent far too many nights at the newspaper till 6 am, I hated to turn down plans with friends. Each time I went into the hospital, I came out of it with an even more relentless attitude towards taking on too much. Did I ever really think taking such risks with my health would work out favorably for me? Did I ever really believe that none of this would catch up with me in the end?

Of course I didn’t. But that didn’t stop me in those days.

My belief in my own invincibility is much more muted these days. Now I am the one reminding my young students not to roam the city streets alone. Between my vigilant attention to local news and surging violence and my evolving realization that none of us are untouchable when it comes to taking risks, I’d sooner spend my last few dollars on a cab then put myself in a potentially dangerous situation that is both completely predictable and avoidable. I am not ruled by fear, but I think about safety much more than I did when I was in college.

In terms of my health, the gradual progression of my conditions has forced me to abandon the notion that the choices I make don’t have consequences. I spend far more time and energy trying to prevent symptoms from worsening and trying to maintain a balance between what I want and what my body needs than I do in trying to “strike back” at illness or prove that it can’t stop me.

Part of this transformation is simply the maturation process all young adults go through, and part of it can be attributed to the fact that at some point, we get too sick to be able to pretend we’re otherwise any longer. For me, this all happened at the same time.

I watched the young girl disappear into the shadows as my bus pulled away from her somewhat wistfully. Sometimes I miss that invincibility, that ability to take such risks without worrying about the consequences—but such nostalgia is fleeting. I may not take the same kind of risks, but I don’t pay the same consequences either.

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Rainy Day Reflections

I’ve been too busy lately to do a lot of things. Writing deadlines to meet, student essays to comment on, fellowship submissions due and a nasty respiratory infection all converging during the same week left me feeling run down and out of touch with the people and the things I care about.

The tighter my chest got, the more achy my leg muscles became, and more I realized how long it had been since I had seen my friends, the more I knew I needed to make some changes:

Step 1: I started a course of very strong antibiotics and resigned myself to using my nebulizer a lot more often than normal.

Step 2: I saw my friends not once but twice on Saturday—and luckily, I had a husband who was willing to chauffeur me around since I was too exhausted to get there on my own. Catching up with some of the girls was wonderful—we keep in touch via e-mails and voice mails, but seeing them in person and having time to really talk was just what we all needed, I think.

Step 3: I read the whole Sunday paper today, something I haven’t had the luxury of doing in months. It reminded me that I was allowed to take some time to relax, that there is a state of being between overdrive and bedridden.

And then something happened that made me even more refreshed and energized. I was at Sunday Mass when they announced they were offering the Anointing of the Sick following the service. I’d been anointed before when I was critically ill, but it occurred to me that I was asking a lot of my body right now and would be asking even more of it in the near future and I could stand to be anointed.

As the priest said the prayers of healing and hope, I couldn’t help noticing the other people who formed the circle around him. There were about 20 of us in total, and together we spanned several decades, several ethnicities, and inevitably, many different kinds of illnesses. Yet I couldn’t tell from looking at any of them what was wrong—and that was exactly what I needed.

Our circle reminded in a very real and immediate way that I am not alone, that every day there are people all around me who must also find ways to balance all the forces in their lives in addition to illnesses. Their challenges might not be visible to the outside eye, but they are still there. After weeks of feeling isolated by my infection and exhaustion and my workload, it was a relief to feel a sense of community.

As I listened to the priest’s words, it hit me that there are many definitions of the word “healing.” I wasn’t looking for my conditions to be healed, nor, I realized, did I need them to be. Healing can also mean returning to a place of hope and faith—in our own bodies, in the ones we love, in the unseen community that supports us when we don’t even realize it, and in whatever form of spirituality or reflection we subscribe to.

Turned out to be the most productive Sunday I’ve had in a long time.

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Blonde Ambition

I saw her again this past Friday night, the same woman I’d seen at the gym a few Fridays ago and whose image haunted (taunted?) me for the duration of my workout.

She was standing in front a day locker, clad in an expensive-looking and perfectly-tailored suit. She was tall, taught, and tanned. She wore sleek high-heeled shoes and clutched an improbably small designer bag. Her straight blond hair was glossy and perfect despite the windy, rainy weather, and the brash fluorescent lights bounced off her lacquered nails and sparkly jewelry. She chatted with an equally put-together and equally tall, taut woman about a spinning class. When you looked at her, you just knew she was someone who never missed a workout or skipped a spinning class.

She certainly looked like she a body that worked the way she wanted it to–and she didn’t look anything like me.

When I was in high school and college, it was the pony-tailed, lean-legged and perennially tan lacrosse girl who elicited such comparisons and insecurities in me, but now that I am an adult and in the professional world, I found her counterweight.
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I am short, I am stocky, and when it rains, my curly blond hair is hard to control. I’d arrived to the gym in my version of “professional” attire—a corduroy skirt, sweater set, and boots with a low heel I’d worn since I had to walk around campus all day and cannot function in heels. It wasn’t sleek or stunning, it was pragmatic and perfunctory. I’d changed into my gym clothes, and yes, I still wear t-shirts from my alma mater (Georgetown), including the cheap ones we used to get in exchange for helping students move into their dorms or the ones they’d give away at campus functions.

I wasn’t there for the spinning class (my muscles felt too weak for that) or to keep up marathon training (the only time I’m involved in marathons is when I am cheering on friends who run them). My goals were much less lofty—to keep the junk in my lungs moving around so it wouldn’t become infected, to boost my energy after a draining week, to lose the vestiges of steroid weight that continually tormented me.

I headed for the treadmill and chose one that didn’t face the room where the spinning class was held.

For obvious reasons, I’d never been much of an athlete (my stint on the JV basketball team was short-lived; my brittle bones broke when I caught the ball at an awkward angle). But I’d always loved going to the gym and feeling like I was doing something for my body that could make a difference. I was proud when I got there and irritated and impatient when I couldn’t. At least that’s how it usually was, except when the same glossy idealized figure I’d been comparing myself to for years re-emerged and made me doubt myself and my presence in that gym.

But later that same night, as I walked to Starbucks to work on my book, I realized it didn’t really matter why both us were at the gym on a rainy Friday night. She might look the part of the well-sculpted, athletic woman much more than I ever will, but I was still there, plugging away on my treadmill and working on strength training. I was doing what I needed to do for my body and my goals, and though they were quite different from hers, they were no less valid or worthy.

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Growing Into Grown-Up Advice

As some of you may have gleaned from bit and pieces of past posts, I consider my father one of the most incredible, inspiring, and memorable people on earth. I write this with no reliance on hyperbole or cliché. He’s overcome more odds than anyone I know and has faced an array of difficulties and challenges so complicated that even the most inventive fiction writer couldn’t have added more incredulous twists.

As a result, he’s pretty damn wise in matters of the heart and of health—or, more accurately, the constant intersection of those two forces.

When I was growing up, I didn’t always want to hear his advice, and if I didn’t tune him out completely, I’d reach into my arsenal of adolescent zingers and sarcastic quips. As an adult, though, I find that I am the one who seeks out his input and feedback. Part of this shift is basic maturity, I think. But with my father, it’s also the fact that so many of our experiences are similar as a result of our medical histories.

Like most people my age (26), I feel like almost every single aspect of my life is fraught with questions. I suppose this never changes and I will find myself asking just as many questions ten years from now, but all I know in this moment is that questions, not answers, rule:

How much time should I spend teaching other people how to write versus working on my own writing?? Am I doing everything I can to manage my health? Can I afford certain lifestyle choices that make being “stable” more likely? Should we move out of our tiny but efficient condo soon, or stay close to my hospital and where we work for as long as possible? Can I conceive and carry a baby, and if medically I can, how do we navigate all the subsequent risks? Are we prepared for the worst-case scenarios? Are we ready emotionally and financially to abandon the time frame for having children we devised when we got married? At the end of the day, is that really even a choice, because is there ever an “ideal” time, especially when you have to weigh so many competing variables? I could go on and on…..

These aren’t rhetorical for me; in fact, I threw most of them at my father in my typical rapid-fire style just the other day and my husband and I were de-briefing him on a recent medical consult. He took it all in, nodding in earnest at points of higher emotion, mulling over other points over in silence.

“You can’t always get the answers you need to pursue the dreams you have. Sometimes you just have to make a decision that might not make complete sense now and grow into it,” he told us. “It’s a risk, yes, but there are very few certainties in this world.”

He reminded us that when he was our age, he had two toddlers and was stricken with cancer and a muscle disease. He wasn’t able to work and was on disability. And yet he chose that time to take out a mortgage on a house for his growing family.

“Was it a huge risk? Yes. Were the conditions anything but ideal? Yes. Did everyone think I was insane? Yes. It was a terrible time to make such a big decision in terms of my health, but I needed to do that then for us to have a future later,” he said.

It was an extreme example, certainly, but it definitely made his point. No matter what the decision or question is—especially where health is concerned—very rarely will we have all the information and facts we’d like. Sometimes we just have to take action or risks in the present into order to grow into them when it matters most.

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And So It Goes…

Usually, I try to craft posts that can stand on their own, essay-type pieces that converge on some central insight or theme about illness and identity that go beyond the minutiae of my own daily life.

That’s usually.

Today I have no larger issue at stake, no idealistic nugget of reflection or speculation.

Right now, I am just frustrated. Frustrated that I woke up yesterday morning and for no apparent reason (or infection), could not breathe and had searing pain in my chest. Frustrated that instead of attending my Saturday fellowship meeting, I was hooked to a neb for hours. Frustrated that I missed my friend’s party and didn’t get to the pile of work or the trip to the gym because I couldn’t sit up without losing my breath.

But deep down, I am more frustrated by the amount of information presented to us at a fetal medicine high-risk consult this past week—or, as it were, all the variables involved in this quest that we have no control over. I am frustrated because I feel so overwhelmed, and every scenario on the table is rife with conditionals and unknowns and extenuations. I am frustrated because right now I can barely find room for joy amidst all the risks and percentiles and negotiations, frustrated that even the encouraging pieces of news seem momentarily drowned out by everything else. Frustrated because I thrive on being in control and crave concrete facts, and I cannot each out and get either of those right now.

I am frustrated because lately when I see babies, tears spring to my eyes without warning and I have no control over that, either. I am frustrated because my body has brought me nothing but complications since the moment I was born and right now I want just one thing, this one thing, to be uncomplicated. I don’t want to have to fight so hard, or give up so much.

And lastly, I am frustrated because I know sound whiny and self-indulgent and everything else I dislike so much and while I should have control over that, too, I don’t.

And that’s it, no threads or parallel narratives to tie together, no concluding statements that wrap it all up neatly and succinctly. Not today, anyway.

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Little Victories, Big Changes

Last Wednesday, I had the makings of a nasty cold. One week later, I have the lingering remnants of said nasty cold, most notably decreased peak flows and lots more wheezing than normal.

And I couldn’t be happier.

A year ago, getting a cold guaranteed I’d eventually end up in the hospital. A few months ago, getting a cold meant I’d spend a few weeks languishing with bronchitis, and I’d start a long course of antibiotics—and often, I’d still end up in the hospital. But for right now, getting a cold means feeling miserable, forgoing all but the most necessary of commitments to get extra rest, and keeping my trusty nebulizer right by my side. I did it—I had a cold, and it didn’t throw my entire routine out of whack.

Knowing my immune system, this will probably still drag on for a few weeks, but I don’t care. It still didn’t get as bad as I’d been conditioned to expect it would. I am not naïve, I know I still need to hunker down for a long, cold winter laden with viral infections, but at least I am starting out my “bad season” on stronger footing.

Maybe I was just lucky this time, maybe the infection wasn’t a particularly strong one or I felt it coming earlier and responded as such…or maybe the changes I’ve been making in my life and in my schedule are beginning to pay off after all. It’s been a difficult mental battle to scale back my teaching schedule a bit, to say no to new writing projects I’d like to tackle to focus on the ones I already have, to actually build in space for resting when my preferred state of being is overly-committed and super busy.

Half the time I hate it, I feel antsy and irritated, like there are so many things I could be doing, so many things I should be doing. Why teach two classes when I could teach three or four and get more money? Why say no to another freelance job when theoretically I could squeeze it in late at night? Why not make plans for a Sunday meeting since my fellowship meets only on Saturdays, thus leaving an open window beyond the confines of the workweek? This is how my mind works, and this is the inner system of checks and balances I need to control.

But today, in this moment, I am beginning to feel the changes are worth it. I wasn’t as run down as I usually am by this point in the semester, and maybe that’s why things didn’t completely explode when I got sick. Like everything, it’s a trade-off, but right now, slowing down a bit seems a lot more tolerable than having my life completely disrupted by spending days in the hospital and falling even more behind.

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A Relationship in Numbers

As some of you who have read previous posts may know, I have been thinking a lot about numbers and statistics lately—what they mean, how they define us, and, more importantly, how they fail to capture what cannot be so easily quantified.

In digging through research for my book proposal, I unwittingly came across the following statistic: The divorce rate in marriages where chronic illness is present is over 75 percent.
(see http://www.mychronicillness.com/invisibleillness/statistics.htm.

Now, I am not here to debate the accuracy of these statistics or discuss the methodology behind them, but they did make me stop and think. I was told recently I had a 75 percent chance of not having children on my own, so I approached this statistic with the same question: How do you know if you’ll be in that lucky 25 percent?

Seventy-five percent of marriages where chronic illness is present do not last. That is an overwhelming number to me, and it might be misleading. People divorce for all sorts of reasons, and it doesn’t necessarily mean there is a cause and effect relationship between chronic illness and divorce. It could be one of many mitigating factors, but looking at the statistic, it’s not possible to weed that out. But certainly between lost income due to sickness, high medical bills, loss of identity, pain, frustration, etc, there are a lot of ways to look at how chronic illness could be implicated in these findings.

Just as with my fertility issue, I don’t think there’s any way to know how to be part of that 25 percent except to try. The odds obviously don’t speak in our favor, but that’s why yet again I am glad that I don’t put too much stock in statistics.

One would think that the stress and tension in marriages would increase with the number of illnesses a person has or the number of people in the marriage who have illnesses—so perhaps a marriage where both spouses have multiple illnesses would really be on the losing side of the odds, right?

But maybe not. Maybe we can look at this from the complete opposite direction. Consider the case of my parents. They married in their early twenties, both believing they were fairly healthy. At 26, my father was misdiagnosed as having muscular dystrophy, a misdiagnosis that lasted seven years and whose toxic steroid treatment left him a diabetic. When he was 32, he had a cancer-ridden kidney removed, the tumor spurred on by the rare neuromuscular disease he’d actually had the entire time (polymyositis). When he was 39, he had a heart attack and an angioplasty. When he was 43, his polymyositis relapsed and he’s been on chemotherapy ever since to try and control it (14 years). Last month, he had a cardiac stent implanted because he had several blockages.

He’s a regular Lazarus in the flesh, no? So how did my mother stand it all these years? Let’s add in the fact the she’s been sick for over two decades herself. She has severe arthritis and degenerative joint disease. She’s had several major reconstructive joint surgeries, has gotten to the point where she’s needed a wheelchair, and is in constant searing nerve pain from her fused spine and crushed discs.

And yet with all the serious illness, the near-death experiences, the years of pain and setbacks and stress and frustration, they have one of the best marriages I have witnessed. They are loyal, supportive and loving towards each other, and understand and anticipate each other’s needs perfectly. I think this is because they have both suffered a lot and therefore can empathize with each other so well. There is no room for anger or resentment because they are too focused on each other’s best interest.

Maybe the more illnesses you have the more you learn to adapt and cope. Maybe when someone you love suffers, you understand your own suffering better and can put it in perspective. Maybe when you’ve been asked to face difficult truths and grim statistics so many times and have always beaten them, you begin to really believe that no matter how bad things are, there is seriously nothing the two of you can’t handle. Maybe you learn that yes, you will suffer losses and frustrations that most people will never begin to imagine, but you also learn that hope will never abandon you altogether, either.

But maybe if we’re playing the numbers game, my parents are just plain lucky they landed in that elusive 25 percent?

Not a chance. They are there because they earned it.

So I have two choices—I can look at the numbers and feel overwhelmed, or I can look at my parents and know what is possible even under extraordinary circumstances.

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Just Say No

For a brief time, I completely forgot that as a patient, I have the right to say “No.”

For years, I’d been conditioned to follow the prescribed regimens and treatment protocols handed to me by a variety of specialists. I was an informed patient—I knew the technical terms for body parts, I knew the correct medications for different conditions, and because I knew my endocrine, respiratory, and autoimmune systems better than anyone, I knew when to question the experts.

Because I had knowledge, I had power. While I spent a lot of time undergoing procedures and shuffling from one office to the next, I knew why I was doing it, and I agreed with the rationale.

This isn’t to say I had become smug, but over the years I had definitely acquired an air of confidence and even authority as a patient. I respected my doctors and their vast body of knowledge, but I realized that in my own way, I had a lot of expertise as well.

And then I entered a new specialist’s office—in this case, a fertility specialist—and any confidence or knowledge I thought I had quickly disintegrated.

I found myself nodding meekly to rapid-fire assessments of my ability to have children, and all sorts of terms and conditions washed over me. I stumbled to wrap my mind around the new words and their implications, and I was always one step behind the physician.

I left the brief consult with a daunting list of blood tests, procedures—some simple, some fairly invasive—and names of other sub-specialists with whom I needed to schedule appointments. I waited in the hall for my blood to be drawn—at least I could cross one task off of my To Do list that same day—feeling completely overwhelmed and completely out of my element.

“This must be what it feels like to be a new patient,” I thought to myself, having never been in this position before.

We were on a mission to rule out every single possible fertility problem first, theoretically making it easier to know what was wrong if I tried to have children and it didn’t work. I’d played this diagnostic game of exclusion before for other problems, but I’d always had symptoms or some sort of evidence to back up these expeditions.

Now, all we had was the knowledge that most people with my respiratory disease, PCD, have trouble having children because like the cilia in the respiratory tract, the cilia in the reproductive system either did not work or did not exist. There is no test or way to find out for sure if this is the case for me, an irony because of all the tests laid out for me, this is the one I really need.

Dutifully, I had my blood drawn. I made appointments with reproductive endocrinology and fetal medicine high-risk specialists, agreeing that it made sense to assess my risks and my medications well before I was planning on having children.

And then it came time to schedule a particularly invasive and painful procedure, one that would rule out a condition no one for one second even thought I had. The procedure itself wasn’t something I’d heard of before or knew anything about, but being a diligent patient, I tried to figure out a time to have it that didn’t conflict with my numerous other appointments, my physical therapy, my teaching, my writing, and my “down” time.

Then I stopped and thought about it, and about all the time I had carved out for exams and consults and procedures and surgeries over the course of my lifetime, all the sacrifices of time and inclination I made to do what was right for my health, what would give me answers I needed.

And I decided this wasn’t one of them. I barely had enough time to do the things I wanted and needed to do; an invasive procedure to confirm I didn’t have what we already knew I most likely didn’t have simply wasn’t a priority right now. Maybe down the road it will make more sense and yield the kind of information we needed, but not now.

“Can I do that? Can I just say, ‘No thanks, not right now. We’ll shelve this one for later?’” I asked my chest physical therapist as the test day loomed nearer.

“Of course. It’s your body and your decision,” he said, surprised that I even had to ask since the old me never passively accepted medical advice at face value.

As if snapping awake from a trance, I realized he was right. Simply because the option was there didn’t mean I had to select it, or that saying “No” meant I was somehow a difficult patient or consumer. Saying “No” meant doing what was best for my body and my spirit based on the facts at my disposal. Even if the procedure and all the terms weren’t things I knew well, I still had a lifetime of experience to help me make my decision.

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