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By Mark Nethercote, August 26, 2011 10:00 am

Tuesday 31st August 2010

One year ago.

Suse is all over the shop.

In the last two days, she’s smashed the Pyrex jug, made a cup of tea with cold water, left me several unexpected presents in the toilet, and strewn an entire box of used tissues all over the house.  She’s got a constant headache, her skin has broken out, she feels increasingly bloated and nauseated, and her memory is shot.

This morning when we woke, I could tell she was on edge.

“Remember I’ve got my phone thing this morning?” I said.

“Sure.  But you’ll be done by 9.15?”

“No, it might take till 9.30.”

“But last night, you said you’d be done by 9.15.”

“No, last night, you heard that I’d be done by 9.15.  I very definitely said it might take till 9.30, because I thought it might be an issue.”

“But you’ve got to give me my injection!”

“Which I’ll do at 9.30.”

“But I’ve got to go to work!”

“And I’ve got to be on the phone.”

“Don’t you want to have a baby?” she said, breaking into tears.

It’s like a dose of turbo-charged PMS.

* * * * *

PMS is the acronym for Pre-Menstrual Syndrome.  We all know what it is, but approximately 5% of the female population know better than most.  According to Wikipedia, PMS is ‘a collection of physical, emotional and psychological symptoms that are related to a woman’s menstrual cycle’, above and beyond the normal discomfort expected of menses.

There are well over two hundred symptoms that have been attributed to PMS.  And these don’t include any of those experienced by their partners.  As an interesting aside, there is thought to be an evolutionary function to PMS, as it only occurs when a woman is about to menstruate, thereby reminding all around her that she has not fallen pregnant.  If her male suitor fails to impregnate her on a monthly basis, then irritability, tension and mood swings are potential motivators for rejecting him out of hand, making way for a more virile partner to move in, get her knocked up, and get on with the breeding.

Ain’t nature grand.

Technically, PMS is a phenomenon isolated to the final days of the Luteal Phase, the period between ovulation and menstruation.  And right now, thanks to our suite of injections, we are well and truly in the trenches of the Follicular Phase.

So, I can’t truly say that this is PMS.  While the symptoms may be similar, it’s a slightly different beast.  In fact, what’s going on here is a fully-fledged dose of POS: Pre-Ovulation Syndrome.  Or, as I like to call it, thanks to the drugs, PT-COS:  Pre-Turbo-Charged Ovulation Syndrome.

With Suse, PT-COS has been triggered because they are totally messing with her hormones.  She’s getting extra doses of some, and antagonists to others.  And while this may sound counterintuitive, it’s not.  It’s actually fascinating.

Unless you’re Suse.

The system in the body that controls hormones is known as the endocrine system.  The adrenals, the thyroid and the testes and ovaries, among others, are examples of endocrine glands.

Endocrine glands receive messages in the bloodstream from other organs further upstream.  At the top of the message system, unsurprisingly, is the brain.  A part of the brain known as the hypothalamus releases a whole bunch of hormones, including one called Gonadotrophin Releasing Hormone (GnRH).  This then floats downstream to the pituitary gland, which sits right at the base of the brain.  When the pituitary gets the GnRH signal, it releases two more hormones:  Follicular Stimulating Hormone (FSH) and Luteinising Hormone (LH).  These, in turn, circulate in the blood stream until they reach the ovaries.  The arrival of FSH and LH is like the green light for ovulation, and on getting this message, the ovaries begin to release their own hormones, estrogen and progesterone. These enter the blood stream, and float all the way back to the hypothalamus, like a messenger letting headquarters known that the signal got through.

The whole thing is a finely tuned balancing act.

Except in IVF.

* * * * *

With IVF, we’re messing with the whole project.  We’re deliberately unbalancing the whole act.  For the last five days, we’ve been injecting FSH straight into Suse’s belly.  Her ovaries, being obedient little things, have start to ripen the follicles.  This is all good and well, except that it means we’ve got extra estrogen and progesterone leaching all around the circulation, having a right old party.  The messengers are telling the hypothalamus to slow down the GnRH release, but with two of the follicles already at 16mm, the message isn’t getting through quite quick enough.

So this is where the Orgalutran comes in.  If you read the pamphlet, you’ll see that it’s ‘a GnRH antagonist, modulating the hypothalamic-pituitary-gonadal axis by competitively binding to the GnRH receptors in the pituitary gland’.

And while it sounds more like something that might occur to insurgents in Afghanistan, what it really means is that we’re blocking the release of anymore GnRH from the brain.   We are competitively antagonising those receptors.  And we wonder why my wife is moody.

LH is the enemy here.  If LH levels get too high, then the follicles will burst early, and we’ll lose the eggs.  So we’ve highjacked the system.  We’ve closed down the natural release of FSH and LH by stopping the GnRH with Orgalutran, and yet we’re continuing to pump her full of pharmaceutical-grade FSH to ripen her up like a battery hen.

And then, in two day’s time, we’ll give her one last jab of artificial LH, to get those grapes good and ripe, and thirty-eight hours later, they’ll pounce.  They’ll grab the biggest needle they can find, and suck out as many as eggs as they can.

But only after she’s knocked unconscious.

* * * * *

So, it’s semantics, really.  Whether this is technically PMS or not, we’re messing with Suse’s hormones.  We’re blocking the messages to her brain, and we’re overdosing her with messages to her womanly bits.

And if there’s one thing I have learnt about my dear wife, it’s that when we mess with her hormones, I will surely know about it.

* * * * *

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By Mark Nethercote, April 7, 2011 10:00 am

Tuesday 6th April 2010

Gestation: 27 weeks, 4 days

One year ago.

Each morning, the light goes on and the thermometer is placed.

“It’s important that the temperature is taken the moment that you wake,” Suse assures me.

This done, she sets her timer and then spits on the microscope.

“You have to leave it for ten minutes before reading,” she intones.

And after that, she rises to pee in a cup.

* * * * *

“I’m done with that test,” she finally said two days ago.

“Thank Christ,” I replied.  “I hate that damn test.”

“Should we drop it?”

“Please.”

On the saliva test, ferning only remained for one day.  The next day we were back to pebbling.  This on its own, was a little disappointing.  After all, everyone knows that pebbling is not as good as ferning.  Everyone who spits on microscopes first thing in the morning, that is.

The plants had hibernated for another month.

* * * * *

Suse’s basal body temperature was up, but less than the expected half-degree.  Again, on it’s own, we were left wondering.  After all, there was the night of mittelschmerz.  But since the ectopic there’s been so much phantom pain that it’s hard to know what’s what.

So this morning, I decide to tabulate it all.  I take Suse’s scribbled little note from beside the bed.

And I put it in a spreadsheet.

* * * * *

I’d completely forgotten the faint line we got on the LH surge test on day twelve.  As hated as that test is, I’d dismissed it out of hand the following day when it again returned a negative.  Hell, we both did.  For three months of wee dipping we’ve earnt a solitary faint line.  Whoop-de-doo.

Yet, when it’s all put together, it looks like this:

Pretty isn’t it?  As a scientifically trained male, the information above soothes my need for order and rational understanding.  And, viewed like this, it looks good.

My own spreadsheet has a sixth column that lists the days we had sex, but I’m quite sure that this is relevant to no one else but us – suffice to say that with Suse’s temperature rising on day twelve, her pee stick showing a faint line on the same day, mittelschmerz a day earlier, and the ferning pattern appearing two days later, that we did our level best to ensure that there were sperm in the right place at the right time.

But what’s more exciting, is that given the chart above, there is a burden of evidence.  And that burden of evidence says that – despite her greatest fears – Suse is, in fact, ovulating.

Sometimes, you need stand back and look at the cold hard facts.

Sometimes, nothing beats an Excel Spreadsheet.  And here, above – exhibit A – is a beautiful little table that warms the cockles of my heart.

Sometimes, when you’re in this far, you can’t see the ovulation for the tests.

* * * * *

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By Mark Nethercote, March 23, 2011 10:00 am

Wednesday 17th March 2010

Gestation: 24 weeks, 5 days

One year ago.

“Hello?”

“Oh, Hi Mark, it’s Nadine.  Have I got you at a bad time?”

“No, not at all,” I say hurriedly, pressing pause on the TV, rising to walk to the study.  “Libby said you were going to call.  Thanks for getting back to me.”

“No problem at all.”  In the background I hear the wheels of the car against the road, and a toddler making his presence known.  Even the Obstetrician has kids.

Everyone has kids.

“So how can I help?”

“Okay, where to start.”

I keep it brief.  It’s 9.13pm on a weeknight, and Nadine has taken time after a working day, and then a lecture, to listen to my bleeding heart.  So, as succinctly as possible, I tell her about the ectopic, Suse’s irregular periods, her negative result on the ovulation test last week.  And that it’s now been five months.

One hundred and forty-four days, in fact.

“And how are her periods normally?”

“Regular as they get.  You could boil an egg to them.”  Silence.  “I mean…they are spot on twenty-eight days.”

“And now?”

“They’ve gone off a bit.”

“Still between twenty-five and thirty-five days?”

“Yeah,” I say, unconvincingly.

“Well, that’s still okay.”

“And what about the ovulation test being negative?”

“Well, they’re supposed to be accurate, but if you miss the LH-surge, you can get false negatives.  And if her cycle is still pretty regular, it’s highly unlikely that she won’t have ovulated.  The whole thing is a cascade dependent on a complex chain of events – ovulation being one of them.”

“Okay,” I say, trying to remember things from medical school.

We talk about alternatives over the next month.  Basal body charts, saliva tests, second-half progesterone levels.  We also talk about potential investigations of her fallopian tubes – dye tests or a laparoscopy.

“But all of this is down the track, right?”

“Yes.”

“How far down the track?”

“Look, fifty percent of people are pregnant within three months of trying, seventy-five percent by six months.  It will have taken a couple of months for things to get back on track after the ectopic and the methotrexate.  So if you’re still not pregnant after six months of trying, it’d be reasonable to check things then.”

I hear the measured tone in her voice, one I’ve used many times before.  I suddenly hear my own tone, pressing for certainty in an uncertain world.  All I can do is absorb this sage advice and run with it.

“But,” she continues, “remember that you got pregnant the first time you tried, which is very reassuring.  Your sperm are good, and her eggs are good, which is the main thing.”

“Sure,” I say.

“We can work with that.  They’re the main ingredient.”

“Right.”

“We don’t need her tubes.”

I pause for a moment.  “Sorry?”

“We’ve got our own.  Test tubes.”

I stop again.  “Right,” I say eventually, the joke clunking slowly.  Humour with truth.  “Right.  Yes, right.”

It’s true.

The line goes quiet for a moment, and I hear further happy sounds from the toddler in the background.  I imagine him looking out the window, watching the cars, humming to himself, amused by the world around.  That’s how it sounds.

“Thank you, Nadine.”

“Sure.  My pleasure.”

“And we just need to keep having sex, right?”

“Right.”

I hang up the phone, and take a breath, before looking up.  By now, Suse is standing there, having listened to the majority of the call from our end.  She has an expectant look on her face.

“So what did she say?”

“The main thing she said,” I begin, ensuring I have her complete attention, “is that we continue to have regular sex.”

* * * * *

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By Mark Nethercote, March 15, 2011 10:00 am

Monday 8th March 2010

Gestation: 23 weeks, 3 days

One year ago.

I walk down the hall, where I meet Suse, wearing another look of despair.  It’s becoming a trend.

“The test is still negative.”

That fucking test.

“Really?”

“It shouldn’t still be negative,” Suse says.  “I’m day fourteen.  Why is it still negative?”

I walk into the bathroom and start reading the packet.  That smug purple woman looks back at me.  I fish the pamphlet out, reading for the first time.  I’ve left this one to Suse.

A pregnancy test serves a purpose.  Being dictated to as to when we should be trying to procreate rubs me the wrong way.

Especially by a stick.

On the bench, a see the offending stick, with its single pink line.  It has a green bar at one end, little triangles in its centre, arrows pointing the other way, the words ‘test’ and ‘control’ bookending it, and then ‘ovulation’ in italics, repeated, on a pink background, at an angle.  Like it’s the brand name.

“Are they trying to copyright the word ‘ovulation’?” I ask.

“Sorry?”  Suse looks around the door, concerned.

“Which end did you dip?”

“The right one,” she says defensively.

“I’m not having a go.  It’s just – really confusing, isn’t it?”  She walks out.

“It is really confusing,” I repeat to myself.

* * * * *

I look at the pamphlet, it’s heading presented to me by a stork.  In its mouth is a napkin with words unfurling from it.  I read through the steps, eventually getting to the section titled: ‘Limitations of the test.’  I keep reading, until I get to a relevant passage.

“ ‘Certain medical conditions may adversely affect the reliability of this test for predicting ovulation.  These include pregnancy, post-partum, post-abortion.’ ”  I stop.  Suse looks at me.

“The ectopic was five months ago!” she yells.

I go silent.

She grabs the pamphlet and starts reading herself.  She reads to the same part as I get to – as I got to – before choosing not to finish.

“Polycystic Ovarian Syndrome, Ovarian cysts, the onset of menopause…”  She stops.  “Menopause,” she says, her voice having dropped another octave.

“You’re not going through menopause,” I say.  She says nothing.  “Maybe the test isn’t working?” I offer.  I grab back the piece of paper from her, reading for the right phrase.  “It claims to work in 98% of LH surges.”

“Yeah, that’d be it.  I’m the one in ten, one in fifteen, one in twenty for everything else.  Why not this?”

I let it go.

* * * * *

Ten minutes later, I hear weeping from the bedroom.  I walk in, to see Suse bundled up in a ball, crying.  I lie down beside her, cradling her.  As I do, she begins to sob, spilling out more emotion.

“I just want to die,” she finally says.

“You don’t mean that,” I say, alarmed.  She pauses, realising how this sounds.

“What do I do?  Who do I go to?  I don’t know what to do!  I’m a mess!”

She breaks into sobs once more.

I think.  I scramble.  I shoot around thoughts, ideas, phrases, arguments.  I paraphrase, rephrase, un-phrase.  I run over it, and over it, flipping ideas, trying new ones.  Trying to come up with something.

We lie there as I feel my shoulders tight, the exertion of attempting to fix it, when there’s nothing to fix here.

I feel myself fall loose.

Eventually I open my mouth.

“I don’t have the answer, Suse.”  I pause.  “I don’t know.”

* * * * *

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By Mark Nethercote, March 7, 2011 10:00 am

Thursday 4th March 2010

Gestation: 22 weeks, 6 days

One year ago.

I walk out of the bedroom and into the toilet.  And there, seated, is Suse.

Peeing into a cup.

“Morning.”

“Morning.”

The seven-day packet – the one with the purple bitch and her perfect baby on the front of it – has been cracked open.

Having sex like rabbits didn’t work.

It’s time to get scientific.

“So, what’s the go?”

Suse looks up.  “It’s an Ovulation Predictor Test.  It predicts when,” she picks up the box, “ ‘your luteinising hormone is elevated, which signals you are about to ovulate.’ ”  She pauses to see I am concentrating.  “ ‘You are most likely to become pregnant if you have intercourse within 24-36 hours after you detect the hormone surge.’ ”  She sits there, as serious as could be, with a the box in one hand and a cup in the other.

“Really?”

“According to her,” she says, pointing at the purple woman.

“So?”

“So what?”

“What’s the verdict?”

Suse holds up the stick, examining it intently.  “Negative.”

“So the test says that we shouldn’t have sex?”

“That’s what the box says.”

“Well, isn’t that just fantastic.”

I walk away.

Cursing that purple wench.

Her, and her tiny, perfect, purple child.

* * * * *

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By Mark Nethercote, February 24, 2011 10:00 am

Wednesday 24th February 2010

Gestation: 21 weeks, 5 days

One year ago.

Suse’s period hit yesterday at noon.

Four hours after the pregnancy test.

* * * * *

We sit watching TV, when Suse grabs at her side.

“Bad pain?”

“Just the usual these days,” she replies.  “You know, it’s uncanny the number of women whose period starts minutes after peeing on a stick.  There’s something biological that they’re playing on here, that fools us into spending ten bucks to pee on a stick just before we spend ten more bucks on pads.”

“Hormones are a bitch,” I reply.

She looks at me, deciding on her reaction.

I wait.

Suse is in fine form.  By which, I mean, her hormones are in fine form.  Right now, her fuse is pretty short.

Add to this yesterday’s negative test and the fuse is lit.

“Yes, hormones are a bitch, Mark.  They’re responsible for bringing my period forward.  I’m three days early, you know.”

“I thought you weren’t sure of your dates,” I say, stupidly.

“Well, I am!  And they are!  Besides, it doesn’t if I’m three days or one day early.  Early is bad.”

“Early is bad?”

“Yes!” she yells defiantly.  “Everyone knows that early is bad!”

I think I missed that lecture at University.

“Okay,” I say.

I stand and start to slowly back away.

“Where are you going?”

“I don’t know.”  I stand dead still.  “This way?”

A frown lines her face.  And then the façade falls.

“I just can’t believe it,” she says, her face dropping in defeat.  “I can’t believe this has happened to me.  It’s just not fair.”

“I know,” I whisper.

“Neither of my sisters had this.  They both got to…”  She pauses.  “They both got to keep their innocence.  To have an experience of pregnancy without it being tainted.  Without all of this worry!”  She stands, having gone moved from defeated to enraged.  “It’s intruding on my every thought!  Every hour of the day!  I don’t know how to stop it, Mark!  I don’t know how to take it easy with it any more!”  She takes a breath, before finishing, this time more calmly, “I don’t know how to have a natural experience anymore.”

Her heads falls, and she sits heavily on the couch.  I approach and sit with her, my hand on her back.

I go to say something.

But there is nothing to say.

* * * * *

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By Mark Nethercote, December 17, 2010 10:00 am

Friday 11th December 2009

Gestation: 11 weeks

One year ago.

Suse has her blood test first thing.

Despite the continued bleeding, it’s been a week since the last test.  For seven whole days, we’ve been told to gird our loins.  Shit, if my loins are to be any more girded, I just might have to purchase a pair of chainmail undies.

At last count, the Beta-HCG was ninety.  Down from 432 ten days ago, and way below the dizzying heights of the mid-three thousands just two weeks before that.

Ahh, the roaring three thousands.  How I miss ya.

And despite our uncertainty, with the unflappable Kath at our side, we’ve made it a whole week without a test.

In fact, we’re doing okay.

So much so, that we’ve planned a trip out of town.  My Dad is directing a musical that he wrote when he was seventeen years old, way back in 1961.  ‘Barchester’ has been forty-eight years in the making.

If there has ever been an excuse to risk leaving the big smoke, this is it.

So it is, that Suse and I are in the car, in our driveway, at 3.34pm.  I look across at her.  We’re both buckled in, but I haven’t started it up.

“What is it?” she asks.

“Are you sure you’re right to go?”

Suse pauses for a moment.  It’s only now that I realise how quiet a dead car is.  She hesitates.

“Yes.”

I nod, raising my eyebrows.

“You sure?”

She looks across at me, a steely flash in her eyes.

“I’m not going to live in fear, Mark.  I’m not going to let this thing rule what we do.  We’re going.”

When I met Suse, the first lesson I learnt – and the one I most often forget – was this:

Don’t argue with a Brock woman.

I start the car, and reverse back, happy for the hum of the motor.  We make it four hundred metres down the road before she turns to me.

“They do have a good ambulance service in Ballarat, don’t they?”

* * * * * *

Mum and Dad meet us in the drive.

“Hello my darlings,” Mum says, taking me in a hug.  I hold her tight.

She then takes Suse in her arms, her little frame leaning up and into my wife.  I watch her bare arms, the muscles in her forearm tensing as she holds on.  They stand there for a moment, sharing something that I can’t touch.  A wordless, physical, womanly bond.  In that split moment, they appear fused.  Somehow, forever closer for it.

I feel my throat burn in thanks.

Patiently waiting at her side, is my Dad.  He does the same.  He takes us each, hugging us each, holding us each.  We melt in turn, relenting, saying nothing.  We are grateful for it;  like two little lost kids who’ve found their way home.

The four of us break apart.  And for a moment we are still, in the driveway, the speckled light dappling through the leaves onto the rambling path below.

No one says a thing.  No one is quite sure what is next, the script for this moment having never been run.  We look around, each at the other;  the light a little softer, made so by the wetness at the corner of our eyes.

* * * * *

Within half an hour, the champagne is flowing.  On the drive up, the concept of treating ourselves seemed lavishly over-indulgent.  But now we are celebrating.  What exactly, we’re not sure.  Being survivors, I guess.  Within minutes, we are tickled by the bubbles, giddy with the possibility lent to us in those first few sips.

Suse chatters away, her spirit freed by the release from the confines of our house.  My Mum listens, subtly steering, guiding the conversation out of the dark corners until the cobwebs are cleared.

My phone rings.  The room hushes instantly.

“Hello?”

“Is that Doctor Nethercote?”

“Yes.”

Suse looks at me.

“Today’s result for Susan Brock…”

“Yes?”

All three of them look at me.

“…Beta-HCG…  Five.”

“Five?” I say, a dumbfounded.

I don’t know what she says next.

I can’t hear her for the noise.

* * * * *

I hug Suse into me as we walk.

“I’m so relieved,” I say.   “So bloody relieved.”

“Me too.”

We head around a corner, the lights of the theatre now in sight.

“I would never have dreamed,” Suse continues, “that I could be so happy to be not pregnant by Christmas.”

“It seems your wish might just come true.”

She stops, pulling me in to a kiss.

“I feel free again!” she says, letting out a huge sigh.

“Because we’re not pregnant?”

“Yes.”

“Which was, in fact, what we both really wanted.”

“Yes.”

I let out a hollow laugh.

“We’re both stoked, because at long last, we’re getting the opposite of exactly what we really wanted.”

Suse frowns for a moment, digesting.  Eventually she smiles.

“Exactly.”

Down from ninety to five.  What a way to make a living.

Bloody great.

We aren’t pregnant.

* * * * *

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By Mark Nethercote, December 9, 2010 10:00 am

Thursday 3rd December 2009

Gestation: 9 weeks, 6 days

One year ago.

Suse and I had the most colossal fight this morning.  Jesus.

Beta-HCG has a lot to answer for.  This is one powerful hormone.  I don’t care if there are only four-hundred-and-thirty-two international units per litre currently flowing through her veins.  With five litres of circulating blood, that’s two-thousand-one-hundred-and-sixty units on board.

And each and every one of them is responsible for a different mood.

I did a lot of looking at the ground, at the roof, or at her, watching in fascination at the spittle forming at the edge of her mouth.  In between, I did what I could to inflame things further.

I still get caught in the same loop.  I still get stuck.  Like a friggin’ amateur.  You’d think I’d learn.  But no.  I still make the same stupid mistake any time a hormonal argument ensues:  I try to reason.

This was a ridiculous argument.  It doesn’t even bare mentioning.  I’ll never have the estrogen and progesterone levels that a woman deals with every single month.  So, you’d think, one of these days, I will learn to not argue back.

But once I’ve started, I just won’t stop.  Back down?  Hell no.

I’m a stubborn motherfucker.

And so is Suse.

* * * * *

The end result?  A very, very heated discussion.

I know that Suse can’t escape it, that she can’t get away, and that this is unfair.  But that’s how it is.  I can’t make myself female, I can’t have this living torment transfer it to my non-existent uterus, and I can’t suddenly deport this feeling of emotional bankruptcy into my own account – although I reckon I’m half way there on that count.

Meantime, Suse’s lovely, dear mother was somewhere in the shoebox of a house we live in, minding as much of her business as she could without a set of earplugs.  If only I’d lent her my Nintendo DS.  If only I’d got her to film it.  Then we could have sent it into Candid Camera.  Or Punk’d.  Or Australia’s Got Talent.  Seriously, we pulled some great lines.  We broke the bank on this one.

The Beta-HCG levels are falling through Suse’s boots.

Yesterday, she was happy and glowing and laughing wildly with friends. Today, it’s bloating, headaches, and two-thousand-one-hundred-and-sixty different moods.

It makes perfect sense.

Unless it’s happening to you.

When Beta-HCG is floated, I’ll be buying in.

It’s one strong currency.

* * * * *

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By Mark Nethercote, November 30, 2010 10:00 am

Saturday 28^th November 2009

Gestation: 9 weeks, 1 day

One year ago.

Ed knocks on the door at 5am, entering quietly.  Suse continues to sleep.

“The beta-HCG has dropped to 964,” he whispers.

“That’s way down,” I say excitedly.  Suse stirs slightly.

“What was it?” she asks, without opening her eyes.

“Two days ago it was 1529.”

“That’s great,” I say.  “That’s great.”

“The methotrexate must be working after all.  And, I imagine, from what you’ve said, you probably passed it earlier tonight.”

We all look at the specimen jar on the bench.  Our child, in a cup.  I feel a chill up my back.

“Anyway,” says Ed, sensing the spell we’re now under, “that’s good news, I think.”  We both nod.

“Hooray,” says Suse hollowly.

“Mmmm.”  He pauses for a moment longer.  “Given these great results,” he continues, focusing squarely on the positive, “I don’t think there’s anything for us to get too excited about.  I’m happy for you to be discharged, Susan.  If you’d like.”

I take a breath of anticipation, before looking across at Suse.

“You didn’t get excited when I came in bleeding from an ectopic, Ed,” Suse says pointedly.  “Sorry to be a worry wart, but I’m feeling a little cautious these days.  What, with the shit that’s gone down in my tubes and all.”  She looks over at me.  “I think I want to wait for an Obstetric opinion.”

“Okay,” I say, trying not to show my disappointment.  “No worries, love.  No worries at all.”  I reach over to touch her hand.  Still cold.

“Yes, fair call,” Ed says agreeing, “very fair call.”

He departs as quietly as he arrives.  Suse falls back to sleep quickly.  Meantime, I toss and turn.  Every time I doze off, there is another a cleaner, another orderly, another someone.  Each time they apologise, closing the doors, and I position myself on my four blankets once more.   Besides – there’s that thing sitting over on the bench.  It’s just a clot to everyone else.  To us, it’s a pot full of emotions.

Finally, I hear a murmur of voices outside.  There is a loud knock, and then the morning ward round shuffles in.  Seven people stand in a semicircle, while Ed retells the story.  There are official frowns and muted gesticulations.  We remain mute.

“I think we should repeat the ultrasound,” is the final consensus.  It’s hard to tell where the voice is coming from.

“Great,” we say.  Both trying to keep our eyes open.   Both not sure who to look at.

We fall back asleep.  Strangely, the next three hours are quieter than those from three to six.  At 11.30am, there is a knock at the door.

“Ultrasound, love?”

Sure.  White with two sugars, thanks.

* * * * *

Suse is wheeled around to Radiology.

“Hi, I’m Joseph,” says the youth with a sparse Movember moustache.  He twitches slightly as he leans in to shake my hand.  His palm is sweaty.  Not quite sure what to do with Suse, he waves awkwardly.  Kind of like what he does with all women, I’m guessing.

“Now, because of the gestation, I’ll need to perform an internal examination,” he says, his voice cracking on the word ‘internal’.  He clears his throat, rolling his thin shoulders forward, trying to stretch the tension from his neck.

“That’s fine,” Suse says wearily, “whatever, Joseph.”

“Okay.  So, I’ll just need to get you to sign a consent form,” he says.   A wise move for a man with a moustache.

Joseph prepares the probe, rolling the condom over the tip with less skill than I had at nine.  He clacks away at the controls on his machine, clearly more au fait with computers than with other parts of the equipment in the room.

“So you’re up here on holidays?” he asks, trying to make light.

“Yeah, Mark was able to get a couple of days off.”

“What do you do?”

“Mark’s a doctor,” Suse says.

The sweat droplets form instantly, just at the edges of the bum fluff on his upper lip.

* * * * *

“We did well to see the ectopic,” Joseph says, wiping his forehead on completion.  The probe swings around in his gloved hand, like he’s the main act at a Star Wars convention.

“So what was the final size?”

“Seventeen millimetres by twenty millimetres,” he says.

“That’s bigger, isn’t it?” Suse asks, looking at me.

“Yes,” I say quietly.

“How much bigger?”

“It was thirteen millimetres by thirteen millimetres.  Four days ago.”

Her eyes go wide.

“How can that be?  When the Beta-HCG was down?”  The last bit she says almost wordlessly, almost winded.

“I don’t know.  I don’t know.”

“It’s still growing?”

“It could just be from swelling,” Joseph adds, trying to be helpful.  “We can’t actually make out what is the actual ectopic, and what is just fluid or bleeding.”

“Okay.  So let me get this straight,” Suse says in her non-nonsense voice.  “We can’t see what’s going on.  We can’t tell whether the methotrexate has worked or not.  No one can make sense of any of this.”  She pauses for a moment.  “But there’s one thing we can say, without any doubt.  That no matter what is going on in there, I’ve got a fallopian tube which is more stretched, and more likely to have been totally ruined than it was four days ago.”

Pretty much.

* * * * *

to be continued…

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By Mark Nethercote, November 23, 2010 9:40 am

Thursday 26^th November 2009

Gestation: 8 weeks, 6 days

One year ago.

We limp along.  We sit around at cafés and on the beach, doing what people do at cafés and on the beach.  But with less energy.

We head into Byron Bay.  We drop into the pathology lab for the blood test, and then we go shopping.  We drag ourselves around, taking frequent breaks.  And slowly, piece by piece, we begin to enjoy the simple solitude.  That is, until my phone rings.

“Hello, is that Dr. Nethercote?”

“Yes, it is.”

“Charlene here with a result on Susan Brock.”

“Yes?”

“The Beta-HCG from today was 1529.”

I stop walking.  Suse looks me in the eyes.

“Charlene, can you please remind me what it was three days ago?”

“Just a mome…”  Suse continues to stare at me.  “1580.”

1580 to 1529 in three days.  It hasn’t dropped enough.

“Thank you, Charlene.”

I feel myself slide through confusion, then indifference, then anger, all in a matter of seconds.

“What is it?” Suse asks.

“1529.”

“What was it?”

“1580.”

“That’s not enough,” she says.

A second later, Suse repeats the pattern.

* * * * *

We both walk out of the store dumbfounded.

“How is it possible to have an ectopic, have methotrexate, have the levels drop, and then have them plateau?” she asks.

Well, this is how:

Methotrexate stops the division of new cells.  It binds to an enzyme called DHFR one-thousand times more strongly than folate does, and in doing so, messes up the whole system of cell reproduction.  As folic acid is needed to make DNA, it literally stops the building blocks of new cell creation.  And as it stops new cells from dividing, those that do so most quickly – like cancer cells, or new embryos – are the ones hardest hit by this drug.

It all sounds great in theory, doesn’t it?  Except that it doesn’t always work.  For us, it sounds like it did work for a while, putting a hold on production.  But it may have run out of steam.   It seems that Suse’s womb really wants to be fertile ground.  It seems this ectopic really wants to live.

We’ve got a tough little embryo that’s implanted in the wrong spot.  Here, like everywhere else, it comes back to the old adage: location, location, location.  Our GPS broke.  It sent us the wrong way.  We bought the best house in the worst street.  But once we landed on Mars, our offspring was ready to make a real go of it.

And the little bugger is still trying.

I follow Suse out of the store and back to the car.

“Open it, Mark,” she says, on the verge of tears.  I click the door open, and we both get in.  I begin to drive, but I’m not sure where.

I pull in around the corner into a parking lot, and park the car.  And Suse begins to cry.

* * * * *

I sit by the edge of the pool while Suse swims.  I try to read my novel, picking up my phone every few minutes to check the reception.  Suse gets out, and I jump in repeating the same.  I look around the grounds, at this perfect paradise, the tropical foliage, the white washed walls, the sultry weather.  It’s a tease when you feel this cold.

We swap once more.  It’s 5.13pm in Melbourne.  Suse touches the edge of the pool, turning for another lap.  When she reaches the far end, I pick up the phone, shaking it like it’s a box of Lego.  At that moment it rings, almost causing me to drop it.

“Hello?”

“Hi Mark, it’s Kath here.”

“So you’ve seen the levels?”

“No.”

“1529 today.  Only down from 1580 three days ago.”  Suse jumps out of the water, running over to the bench, splashing me as she does.

“Right.  How is Suse’s pain?”

“Oh, it’s not great,” says Suse loudly into the speaker phone.  “I’ve been bleeding for a month, Kath,” she says, pointedly.  “I’ve had pain for a month.”

“Where’s the pain right now?”

“Both sides.  But mainly on the left.  Should we organise to come back to Melbourne early?”

“When are you due back?”

“Sunday night.  Three more days,” I say.

Kath is silent for a few moments.  “No, I don’t think so,” she says finally.  Methotrexate works in 90% of cases.”

“Okay, but we’re not real hot on the stats right now, Kath,” I say, laughing hollowly.  “Only 3% of pregnancies are ectopic.  We’re not exactly hanging out in the lucky corner at the moment.”

“Yes, I understand,” she says.  “I still think the most important thing is for you to enjoy your holiday.”

“Oh, look, it’s been a blast,” says Suse sarcastically.

“Yes, yes, I’m sure,” she says solemnly.  “But all the same, I still don’t see that you need to break your plans at this stage.”

“So what next?” asks Suse, her voice tense.

“Well, I do think you probably need more methotrexate when you get back.  We’ll do a blood test first thing Monday, and if it hasn’t come down considerably, we’ll give you some more.”  I look at Suse.  She holds her belly like someone just shot her.  “Just try to relax,” Kath continues, in a completely un-facetious way.  “Try to make the most of the nice weather.”

“Okay.  Thanks Kath.”

“You’re welcome.  I’ll see you on Monday.”

The phone goes dead.  I look across at Suse.  She is white.

More chemo.

Chemo, chemo, chemo.

It just gets better and better.

* * * * *