August 25, 2000
We got up early as we had to be somewhere in downtown Denver by 9:30 and John had a plan to eat some breakfast somewhere. So we were up by 6:30, and I got in a good, long shower and a toaster strudel to hold me until we actually found food. We were out the door a little after 7. Took us until about 8:30 to actually get to the freeway exit along I-25 as rush hour traffic wasn't particularly easy to get through.
The whole time I'm just kinda low-level scared. And the odd thing is that it's not really of the needle or the procedure. It's the whole, how is it going to turn out? What's going to be wrong? I have a really, really awful brain and habits that harp on the possibilities of what's going to be wrong instead of having a far more balanced view of the probabilities. I'd been told that it was just half a percent chance that there might be Downs, perhaps up to a two percent chance that anything might be wrong at my age. Which seems small to most people, but that it exists at all just eats away at my brain.
I know I don't write with that constant drone here in the journal. I avoid it when at all possible, as I don't need to encourage it. When I write something, every day, about what's going well, about what is beautiful, about something that strikes me it cuts off the drone, cuts off the relentless wearing away of that kind of thinking. The more I can think in more useful and realistic ways, the better it gets, and I use the journal, in many ways, as a good exercise to stay at a level that is different than that.
Problems sometimes come with helpful people that try to warn me of what can go wrong, or especially those that try and point it out as an inevitability. My brain latches onto those thing like a lab to a tennis ball and won't let go and will worry it and chase it and haul it back to me constantly until it just makes me really upset. If I don't write about the worst case here, it's cause I already thought of it and realized it's not realistic. Thank you for your concern.
I fought it the best way I knew how. Mostly by listening to the radio, talking with John and when we got off the freeway, looking for a good place for breakfast. Intently watching everything that goes by. A little bakery that's been shut down and closed and can be leased. A local donut shop, not part of a chain, with police cars and a sign proclaiming 'Denver's best donuts!' but it's on the other side of the road and fat pills aren't my best friend at the moment. A wild miss of a turn and John keeps going and finds a safe place to turn back and make the turn.
We made the turn and saw, right in front of us a Gunther Toddey's, which is a local chain of diners with obnoxious but really efficient waitresses and 50's style diner food. All the good stuff like chicken fried steak, smothered meatloaf sandwiches, hot turkey sandwiches, and good old biscuits and gravy. On the window was a $2.99 breakfast special, which turned out to be the equivalent of their weekend $4.99 breakfast, so we got a pair of those. Eggs, meat, hash browns and toast, all standard diner fare. It was incredibly cheap and very fast, and my plate came with far more food than I could eat. Crisp bacon, enough scrambled eggs to make me think they probably put the equivalent of a three or even four egg omelet on my plate, and the hash browns were tender on the inside and crisp on the out.
So I was well satisfied when I got out of there. Comforted.
We arrived pretty quickly at Dr. Henry's office. The ladies up front handled us efficiently, getting all the necessary insurance information and ushering us into a room with a VCR and they started the tape. It was a good half an hour of pure data about why one should do this, what was going to happen in exacting detail, and what one could reasonable expect from the results. The why's included some pretty graphic examples of what happens when entire chromosomes get mixed up. Which didn't help my fears any; but the thorough detailing of the procedure really did help a lot.
With the tape over, a genetics counselor showed up and we went through family trees and possible genetic problems. It seems to help that John and I are from completely different ethic backgrounds, recessives don't match up nearly as readily with the mix. They seem to be able to screen for a good number of possible defects if they know to look for them; but we didn't give them much additional testing to do.
From there to the ultrasound. I thought that we were only going to do an ultrasound to figure out where the embryo was so that it wouldn't get stuck. Instead, they did a thorough examination of everything they could think of as indicators for possible problems. Stuff like limb length, head size, belly size, checks for major organs, blood flow, flow through the umbilical cord, how the placenta is placed, and even various structures in the brain. In the process of all the checks there were breathlessly astonishing pictures of the... well... kid.
All the ribs and spine were laid out in glorious detail. Every section perfect, in line, gracefully curved. I think that astonished me the most from the start. How much there is to a human skeleton and having it all laid out, visually, in front of me in such astonishing miniature was just mind-blowing. The arms and legs were ended in perfect little hands and feet. From top of the head to the butt, the critter is about 10 cms long, only four inches. Yet, even so tiny, the ultrasound lady could find its kidneys, the ventricles of the brain (which are only supposed to be a certain size and no larger. If it is larger it's an indicator of Downs, along with shorter limb length), see the exact motion of all four chambers of the heart, measure the bones of its limbs, and go all along its spine and see each vertebrate. We could see all the kid's features, now, the shape of its skull, the new flaps of its ears. It looked like a baby, tiny enough to fit in ones hand.
Best of all, everything on it looked normal and all the measurements were within millimeters of the normal measurements. The pictures were far more reassuring than all the words in the world. None of it is for sure; but it's a clear case of me, once again, being far more afraid of what could go wrong than what actually had.
The fish-baby was also continuing its camera 'shyness'. Though it couldn't get completely away from the ultrasound crystals, it did thrash around like the fish it is. Arms waving, legs kicking, head bumping up hard against my cervix. Now that I had visual feedback, I could feel when it was kicking and I could feel where its head was. What I'd thought were just stomach flutters or gut jitters or bladder contractions had, all along, perhaps, been the fish thrashing about and break dancing on my bladder. The bugger.
One of the things that impressed me the most was the color heightened sense of blood flow. There's Doppler effects going on in there, so you can actually tell when blood is flowing towards the crystals of the ultrasound and when blood is flowing away. So they checked flows through the cord and through the major blood ways of the fish. The checks of the heart and lungs were spectacular, red and blue star bursts of motion, tracing the sheer complexity of what had already developed and grown there.
With both the ultrasound lady and Dr. Henry, the fish just refused to let them get a certain angle on its head. Finally, Dr. Henry surprised me by pushing up and down on my tummy, pretty fast, and I could see the head bouncing up and down in its protective fluids and sac from the jiggling. It startled me, but the kiddo refused to cooperate or turn. So we left it for a bit to actually do the procedure.
Dr. Henry was a delight for data sponges like John and I. He talked every second about what he was seeing, about what to expect, and about what he didn't see as well as what he did. He was very explicit about saying that he didn't see anything abnormal whatsoever or anything that might concern him because he would have said if he had. Lots of delightful run-on sentences filled with information about how he was judging things, and a few nice jokes in as well.
From the ultrasound studies, Dr. Henry had marked a probable entry point. He also used the ultrasound to determine exactly how far in he had to go to just hit the uterus and get in the embryonic sac. He told me, at that point, that I was skinny, though all pregnant ladies think they're fat, I had about two inches from surface to fluid and a normal shot usually goes an inch and a half anyway. Since the kid's head and chest were well wedged down near my cervix, higher up was the best place to go, where the fluid was completely clear of baby. The placenta was nice and was all along the back wall of the uterus so was completely out of the way. Dr. Henry iodined my belly around the mark, laid a sterile sheet over everything but his point of entry. He gave me a quick local anesthetic, which stung a bit. He then put the ultrasound down alongside the entry point. We watched the needle go in.
It was so cool. The needle itself has a solid core, so they don't core me while going in, no need for Mom cells in with the baby sample. And we could see where and how it went in even as I felt it. It really did hurt less than the anesthetic, and with the ultrasound we could see the slender wire slide through the uterine wall into the sac and I could see him position it so that the tip was near the opposite wall. This was so that if the baby did thrash as we were pulling liquid, the kid would only hit the side of the needle. There was no way the kid could hit the pointy bit while it was supported at the angle it was at. Keen to see.
So they pulled fluid out of me. First pulled the central wire out and as quickly as feasible, he pulled two and a half syringes of clear, gold fluid out of me. Breathing was a bit odd, feeling that steel in me, but so long as I drew shallow breathes, everything seemed okay. With the thinner, 22 gauge needle, it took maybe 30 seconds to draw everything, and it was worth the extra few seconds to have the skinny needle. It was also about twice as long as was necessary for me; but it makes sense that they had margin for more fat layers over the kid.
And that was that. Dr. Henry pulled the needle and immediately put a dressing and light pressure on the entry point to make sure nothing bruised or bled. He then used a bit of alcohol to clean off all the iodine carefully off every inch of skin, talking all the time about the first lady that made him very aware that he should do that carefully. Then we got the ultrasound going again and checked to be sure that the kid was okay, that the sac hadn't lost significant volume from the withdrawal and basically get a good 'after' check of how things were going.
The kid had settled a little, and gave Dr. Henry a better angle for the head cross sections. So we got to see every lobe of brain the fish has, along with all the spaces and measure it all thoroughly. It was interesting seeing the jaw and teeth buds and nose of the profile. It was perfectly fine.
The stick was smaller than even a blood donation would do, and with Dr. Henry's pressure and Band-Aid, there was zero bruising even.
It was interesting realizing that the whole thing had been as little as I'd expected per the procedure itself, as all the information I'd gotten had reassured me and it wasn't terribly painful or difficult. What I hadn't expected, at all, was this sudden evidence that my gradually fattening belly actually held what could be thought of as a baby. A human being was gestating in there, with all that astonishing complexity and all those systems already working in such complex perfection. Mostly, before this, the pregnancy has all been about how hungry I am, how awful I feel, whether or not I'm tired, the changes in my body, and the careful watching of weight gain. Suddenly, there is real evidence that it all is really for someone and something else, a miracle of complex systems all working together, and not just a thrashing fish-like creature on the end of an egg.
Okay, so the kid's still thrashing about like a fish; but its actually now kid-like.
Hmm. Carl didn't want to know the sex. I did. I hate surprises. Carl hates spoilers. So as a compromise, for those that want to know. Here is the info as to what the kid's likely to be from visual evidence. Still not 100%, but the chromosome map that's coming to me will be absolute. I'll *try* to keep the fish's gender undisclosed except in spoiler links, so Carl can read and not know, but five months is a long, long time.
It was pretty cool, in some ways, as Mom worked in a lab that did karyotypes all the time, for the same reason these guys were doing me, back when it was a bit more dangerous. But the main idea is that just before cel division, all the chromosomes in a cell suddenly pull their DNA into a nice, tight bundle, double all the chromosomes and then start to split the cell. The cell is supposed to get one of each pair into each split cell. If the splitting cell is frozen right then and there, each neatly bundled pair is very obvious to see. 23 pairs, 46 chromosomes, and all neatly compact so that a picture of them can be printed, cut out and matched up. Most of the things that are easily caught have to do with entire chromosome pairs missing or added! Which is pretty major, but easily spottable through this. There isn't specific genome information they look for unless you have familial history of the few they have mapped.
I left a lot more reassured than when I arrived. All the visual evidence points to a completely normal pregnancy. As Dr. Henry said, "Interesting cases are good to study in school, but you don't want to be one. And in your case there was nothing to make me go, 'Hmmmmm...'" So it's looking good, so far.
John was an utter sweetie and took me, on the way back to work, to Lawrence and 19th, where the Japanese market was and we wandered through there shopping for stuff we couldn't find in the Boulder Asian markets. I got fresh ramen, pickled dikon, and various other things as well. We loaded it all into the car and went to a little fast food place in the Japanese mall and I happily had a really hot, fresh bowl of Katsudon, where the eggs were perfect on the cutlet with yummy sauce over the perfect rice. The miso soup satisfied something deep, and the ginger salad was crisp and tart. All for $6, not a bad deal at all.
Then back to work. I was feeling just fine, and worked cheerfully at stuff until 5:30, which is when we had to go home to get Fezzik to his chemo. I nuked a couple of White Castle cheeseburgers while John loaded Fezzik into Borax, and I just ran out with them on a paper towel, with a can of grapefruit pop, to eat while John drove. I needed something to eat, and it was perfect.
We made it in time, and Fezzik got examined right in the waiting room, sadly his lymph nodes seem to be swelling again, not as badly as before on all of them, but enough that it's likely an indication that the remission wasn't complete. We can fight it with more frequent and harder doses of the chemo drugs, and given that they only seem to make him feel better, it clearly seems the thing to do. So he got his vencrystin, and when he was done, he came charging back out to the waiting room, with the nurse trailing helplessly behind him holding his unattached leash. When they pulled the needle and gotten the bleeding stopped, he'd just gotten up and walked out of the surgery. Dog with a will. It surprised me to see him wandering about without a leash, but he was good and didn't surprise the cats any more than he had to to get to me and then to get out of the door.
John stayed inside to pay the bill while I meandered with Fezzik about the front lawn. He sniffed everything, marked certain places, and wanted to go off to do more. It was mildly sad to find that I could stop him from going, as his hind legs weren't as strong as they used to be. As a young dog, he could pull bleachers with people on them, much less just me. Old dog, now. I'm gradually getting used to the whole idea. Kathy once said that you mourn just as much, it's just that with time, you get to spread the mourning over it all and you get to do the things to make sure you don't have any regrets after. I think she's wise.
We piled Fezzik into the back of Borax and took off for Dairy Queen and Fezzik wolfed down his cone happily. We had our ice cream as well. We didn't get anything at the grocery store and did, however, get a video. I picked Anna and the King, as I like Jodie Foster and Chow Yung Fat, but after hearing a few reviews of the movie couldn't quite bring myself to see it in the theater. We could watch it any time in the next five days, which was nice.
Neither of us were particularly hungry on getting home. Fezzik enjoyed his dinner a lot. And John decided he should eat something more useful to his body, so he made quesadillas with leftover taco salad filling and cheese in flour tortillas. It was yummy, and fun to munch a bit while watching Iron Chef.
John and I had fun calling people with the information we'd gotten today. Mom and Dad were having their anniversary and they really liked the information. They were having Kathy over for dinner and were having fresh crab together. I envied them. I bet there's somewhere I could find fresh, live crabs here, but I have no idea where. Kathy had fun talking with both John and I, and ended up doing me the great good favor of telling me that Mom had been two weeks early with both of us. So there's a good chance that the kiddo will be early, too. A good thing to know when planning when to get the hospital bag packed. At least two weeks in advance. John was laughing when he said, "Okay, you've now set up an expectation and if the kid's late, it's your fault..." Kathy acknowledged it and laughed as well. Still, better to know than not.
I went to bed after the phone calls and fell fast asleep. So fast that I started snoring a lot, and John poked me a few times all night to get me to try and turn around or something. That was funny after so many times when he'd done that to me!