January 19, 2016

Incantations and infertility

They say that surgeons have egos. Sure, it takes an ego to take a scalpel and cut into the skin and wage war against illness and injury inside the belly. It takes an ego to remove organs, to tie off vessels, and to control bleeding. But the humbling thing about surgery is that sometimes, you don't succeed. Sometimes, the damage is worse than what you can repair. Knowing when not to operate, in fact, is what makes a surgeon great. 

Ego is one thing; a God complex is another. Infertility doctors are certainly at risk for this. The finely-tuned machinery of endocrinology keeps ovulation on track, your metabolism in check, and all of it can be manipulated with perpetual blood draws and precisely-timed doses of medications. 

Every new patient visit brings a couple praying for a miracle. The fear is in their eyes that tear up at the slightest provocation; it's in their voices that quiver with uncertainty. They come in supplication to sit across the desk from the doctor who is willing to promise that there is still hope for them. He jokes that if he could predict the future, his middle name would be G-O-D. He laughs, but underlying his laughter is belief that he will be able to counter any finding with a solution. When he explains that he can almost predict the hour of ovulation, it's not an empty promise and it's not a joke. That level of certainty is guaranteed to inflate a healthy ego. 

Part of me is in awe. Many couples come through the door and explain that they are back to try again, that the last time they were here they left with a baby, and they are here for the same magic. I see patients' ovaries swell with follicles until they're ready for retrieval, a veritable factory of eggs produced on command. At the same time, though, there is heartbreak here. The cycles that end with not enough eggs, the embryos that never grow, the ones where the heartbeat doesn't show up on the next week's ultrasound, the patients whose cycles once again must end in a miscarriage. Time and again, I see patients faced with disappointment and the betrayal of their bodies. 

Our bodies and minds are programmed by evolution to go forth and multiply. Society ingrains this, too, for without fertility society is destined to fail. The desperation of that primal desire to leave something behind, some vestige of our genetics in the form of progeny, is what makes each consult fraught with emotion. As an observer--nulligravidous, single, not even trying to get pregnant--it is anxiety-inducing. I have to remind myself of all the patients in our regular clinic who barely have to think about sex and end up pregnant, of the patients who are older than myself but still find themselves pregnant without any difficulty. 

Before medicine, a couple might have resorted to folk remedies or charms, old wives' tales or superstitions in order to bring fruit to a barren womb. Now, they sit before the Wizard, hoping that the man behind the curtain with his injections and ultrasounds will give them what they most desire. 

It's enough to swell anyone's head.