Saturday, August 27, 2011

IVF Journey - Part IV, transformation

Having failed three ivf cycles in a row, I had changed from being confident to less calm and eventually to desperate. I was also increasingly sensitive to and jealous of every single pregnant woman in the world. I refused to go baby showers. I made sure no one talked about their lovely babies in front of me... In the mean time, I would find every possible opportunity to bring up this topic to Fabrice's attention, as if he did not know. I told him, repeatedly, "I wanted to have babies, I wanted to have them, NOW!" I picked up fights for no reasons. I threatened a divorce, since he did not want any kids anyway, it was all my wills to go through the dreadful ivf. I hated him so much for avoiding this very topic each and every time when I brought it up. Fabrice, the poor young and naive husband of mine, did everything he could to distract me from those frozen embryos, future babies, failures. He took me out, running, biking, swimming, rock climbing, canoeing, skiing... He later told me that he was trying to tell me life could be good TOO without kids. He tried to pull me out of the vicious cycle. However, regardless what we were doing, I could not take my mind off those embryos. I was anxious. I cried, cried, and cried more... Until one day, our dear friend, Theodor, showed up, in the early Spring of 2006, right after I failed second frozen cycle.

Theo's came all the way from Germany and we usually see each other once per year at our common annual conferences since we work in the same research field. But the year of 2006, he decided to take his newly wedded wife, Marlene, to the U.S. for their honeymoon trip. Our house was their last stop. Theo, Fabrice and I were trained in the same lab, as slaves postdoctoral fellows together under a very famous principal investigator who has now several drug patterns. Theo is one of the three people in the world that both Fabrice and I could talk to with complete and utter honesty. Just to let you know, if you want a productive postdoctoral life, you cannot also be reproductive. Because you should never ever be thinking about having babies of your own. You should hardly have time to eat, sleep, or even take a long running water shower. I had to tell you this to explain why Theo, Fabrice, and I had become dear friends. We were all singles at that time, ok, this may not be accurate. We all had girlfriends or boyfriends, but our respective partners were not in the same country or same city with us: Theo's girlfriend at that time was in Germany (Marlene, his new wife is a replacement, just so you know), Fabrice was having a break with his dozen of girlfriends who were all in France, Mine was 3 hours flight- or 16 hours car-ride away. So we acted like we were all happy and worry-free singles "after" work, that means our short lunch break and after midnight. We usually worked upto midnight and then Theo and I would hang out in some bars until 2 am. Fabrice was/is not a night person, so he only joined us for fun Friday or Saturday night. This special arrangement made us quite close to each other, so close I even dated Theo and Fabrice both (not in the same time period, so please don't call me slut!) Eventually, Theo left the U.S. and told me that he would never get married for life.

Few years later, Fabrice and I married. Theo did too, soon after that. His visit to the U.S. excited us: I was happy because I thought I finally found someone who would "understand" and be willing to talk to me. Fabrice was happy because he could finally get rid of me, even for a short while, I guess. However, the very news that Theo brought us was that Marlene was 5-month pregnant and they were expecting a baby sometime in the end of the year! What a bomb that he just dropped?! We (maybe just I) obliged to say something like congratulations and then quickly moved on hitting those bottles of beers -Theo loves cigarettes and beers. One bottle after another, we did not care about the fact that Marlene could not drink. That was her own fault anyways, I sure was too angry to realize what a insensitive and nasty hostess I was! We chatted about our good times, bad times, we imitated our boss' voices, as we always did while together... Finally after enough alcohol in my blood, I spoke. It was my turn to drop a bomb, "So what made you change your mind? I thought you did not even want to get married, let alone to have babies." "Oh, I still don't want any kids, but Marlene insisted. I just hated to disappoint her." He answered and looked to the direction of our quest room. Marlene had excused herself to go to bed, must be a while ago, but I had not noticed. She must have been tired from incubating a baby inside of her, I thought. Plus, she did not share the intense life with us and would not have enjoyed listening to our old time stories anyways. Not mention that we were all quite drunk at that time. "Was it easy for you to conceive?!" I had to lead the topic to a good direction, you see. "Oh, she stopped the pills and got pregnant right away." Theo said, without any emotion, as if it was the most effortless and natual thing in the world. I had to ask. I was feeling so stupid and did not know what to say after that. Remember, Theo is the last "boyfriend" that I had. In fact, if he had said yes to my "indecent proposal" of having babies with me without a marriage years ago, my life would have probably not had Fabrice in it.

"So, what about you guys. Didn't you say that you wanted babies years ago." After few more beers and cigarettes, Theo finally asked.

Alright, he asked for it! Great! Now I could start! I then described to Theo in details about our adventures of the ivf journey... He patiently waited for me to get to a point, with cigarettes and beers in hand, that was not too difficult. I know him well enough to go on and on and on... Finally, I ended by, "So we now have 13 embryos frozen, waiting to start next cycle."

Having shared the same bed with me before, Theo should have supported me, right? No! He proceeded to explain what a wonderful life one could have without kids. He saw kids as responsibilities and he also sided with Fabrice firmly, "You can always adopt!" he said, honestly and sincerely. "Exactly what I told her!" Fabrice joined in at this very moment. I had to confess here that Fabrice had indeed suggested us to adopt, but he wanted to wait at least for another 5 years. He had wished to spend some quality time together with me, the old and infertile lady, while we could, he said. "But I have waited long enough to find me a perfect husband to have babies with!" I told him. I had to pretend to look into adoption to make him to go for ONE ivf cycle. In between ivf cycles, Fabrice kept trying to change my mind. He tried, hard, to convince me his genes or mine were not the reasons to have children. Had he not known me at all? I am from China, we Chinese believed our genes and heritages! Well, at least, I did.

Theo and I had spent enough time in bars, movie theaters, restaurants, and even beds, which warranted him to say the forbidden word of "adoption" out loud without hesitation. I also believed/knew that would have been his option also if he needed to make any choices in baby-making process. Seeing my eyes had become teary after that, he tried to stop me from crying, "I mean you will soon have your babies. You still have 13 embryos frozen. You will have two, as you wished!" He knew I always wanted two babies, preferentially a girl and then a boy. Well, given my age and the ivf that we were pursuing, I even wished they came in the same time! "It's easy for you to say since you got your wife knocked up without even trying!" I wanted to say that but instead I heard myself saying, "How could you be so sure, we have already spent 6 of them, but look at the outcome!" I almost cried, "I could wind up having no babies at all!" 

The thought that Fabrice and I would not have our biological babies just about to kill me. Not only because I am from China, but also I am a geneticist, I would really like to know what a green-eyed, tall, slender, handsome European man and a brown-eyed, short, chubby, and ugly Chinese girl can make.

After a while of quietness, I started my attack, "You are such a hypocrite!" I remembered to use my best weapon. Again, Theo and I say things like that to each other, often. But this time, I was for real. I started to hate him for "lying" to me. He had told me that he did not want to get married, but he did. He had said that he would not consider of having any children in the future, because they would bring burdens to this overcrowded world, but he did! I could not let him slide this easily. Theo then spend his remaining vacation week to educate me with something which I never thought that I could accept: he told me that genes and traits that I cared about in my future children were not that important. The important thing was how to parent children - it would involve so much more than giving them your genes, he said. He echoed Fabrice, word by word!

"You need to see things further than your nose." Fabrice chimed in again. He had been quiet all these time. Silently, he had been enjoying to have a perfect accomplice!

Strangely, with Theo and his pregnant wife's presence, I started to listen to Fabrice. He finally could get his ideas of adoption across to me. I don't want to bore you with the lectures that I had received from Fabrice. The bottom line is at the end of Theo's visit, I finally opened my mind to other possible way to become a parent. Eventually, my focus changed, I did not like to be trapped in the seemingly endless cycles any longer. I agreed to Fabrice's suggestion, from the bottom of my heart. I saw the light at the end of the tunnel. Fabrice worked hard on me and we had decided regardless how a great responder I was to ivf drugs, we would NOT go on for another fresh ivf cycles. One full cycle, that was all that Fabrice agreed on before we did ivf anyways. We would continue another frozen cycle to give our remaining 13 embryos and ourselves a chance, but we would not go on for any more ivf cycles.

Once I got that straightened out, I was a different person. In the next ivf cycle, I found myself hoping to end it quickly. I wished it would work, of course, but I had not focused on the outcome of that particular cycle any longer. I was kind of anxious to move on my life with new goals. It felt like that I was completely ready to be done with ivfs. 

Guess what? Ever since I transformed myself from "no kids of my own, no life" to "it's great too to adopt", we have not experienced another failed ivf cycle ever again. Every problem has a solution, no? I finally found my answer to infertility. I understood that life is wonderful with kids in it AND it is equally wonderful without!

So, if you have the patience reading through my chiglish until this point, you would find that we had total of only ONE full ivf cycle. Following that, we had 1 canceled frozen cycle, 1 failed frozen cycle in which we had 4 embryos transferred. And then, the rest of the 2 frozen cycles brought us 2 miracle babies. The first started in May, 2006 with 6 embryos transferred, which led to a baby girl, Mia or ZhuZhu. The next started in June, 2008 with 4 embryos transferred, which brought us Remy or NiuNiu.  Indeed, our remaining 13 embryos had transformed into 2 beautiful children!

What is the magic that opened my mind and transformed me, other than having a wonderful husband who gives no importance to his own genes? I will talk about that in my next post.

Stay tuned! 

Friday, August 19, 2011

IVF Journey - Part III, frozen cycle II -

My ivf clinic is not rated at top in any category, but it certainly is one of the best in town. In fact, even my ob/gyn who has produced first test tube baby in town recommended us to use this fertility center. However, after two aborted cycles, I began to be in doubts of our choice. It did not seem to be a medical necessity to me to abort both my previous cycles. "A high risk of OHSS" was more like a risk of messing up the holiday long break of my ivf clinic. "Dominant egg" sounded like laziness. Could a HCG trigger shot get rid of it? They had the ultrasound machine to follow the egg precisely, did not they know that the first test tube baby Louise Brown was produced by following Lesley Brown's natural cycle? IVF by following a natural cycle is still a common practice nowadays in the Europe, my REs were either too conservative or too incompetent to do something uniquely fitting each patient's need, I suspected. Or better yet, they just wanted to keep me coming back for more cycles so that they could make more money out of me.

Once one is paranoid and anxious, she/he is also unreasonable. I started to shop around for new infertility clinics in town. I lined up with the REs that I would like to consult with while I was waiting for the start of my third ivf cycle. Every new RE sent me right back to where I came from. Don't get me wrong, they all liked me as a great responder to ivf drugs but they did not believe that they could do any better than my fertility center. "Change clinics at this point is not a good idea, especially you have already 19 embryos collected." They sounded like as long as I had one cycle completed, I would bring home a baby for sure. At least, that was what I believed.

There I was. Continued to be with my old clinic, I started my third ivf cycle in Feb. 10, 2006, by taking 21 days of BCP. This time, again, was a frozen cycle. If you have ever done ivf procedures yourself, you know what's like. An ivfer generally needs to visit the clinic every other day once the stimulation (of follicles) starts. However, if it is frozen cycle, meaning transferring frozen embryos, it only needs to prepare the endometrium of your uterus to become competent to accept incoming embryos, your visits to the ivf clinic can be quite sparse, which is good and bad. The good is that you don't have to "disappear" from work frequently; the bad is you feel like lost since you are taking BCPs, injecting Lupron, putting on E2 patches, and taking E2 pills, but you really don't know whether they work or not. At Feb. 27, 2006, after 17 days of BCP, I went back to the clinic. The E2 was measured at 2 and one egg at 4.8 mm but no additional cysts in my ovaries were found in sonograph. I was then given the order to start Lupron on Feb. 28th, which would overlap with the last 5 days of BCP to make sure my ovaries suppressed. "This time, make sure use the right dose!" I was told since in the last frozen cycle I had used mini-dose of Lupron that might have jump-started my ovaries instead of suppressed them!

One week following the last visit, I was back to the clinic again. This time, the E2 rose to 10 but no cysts found, great! "Everything looked okay and go ahead to start the E2 patches on 3/8. In the mean time keep taking Lupron until 3/13." I was told. The nurse/RE wanted to make sure that my ovaries did not make mature follicles this time, they overlapped the initial stimulation of E2 patches with Lupron suppression. Progress was made! I had not reached this stage in the last frozen cycle. I was happy. I also felt confident. This is common among us ivfers, you know. Each new ivf cycle, one always begins with confidence, hopefulness, and excitement, then moves on to anxiousness, worry, and doubtfulness, finally progresses to spectacular disappointment, sadness, and hopelessness. We call it "roller coaster ride". At least that had been what happened to me, twice already, so far.

In fact, at the third cycle, I was feeling like a veteran. I had enough time to surf the Internet for information about ivf. I had enough time to consult other REs, and I was getting used to the ivf clinic, and most importantly, I was getting to be known by the nurses, sonograph technicians, and receptionists, by the first name. Although they still did not like to make any eye contact with me, I adapted to enjoy being just a number to the clinic - Later I figured out why the clinic staff generally don't like to smile or to talk much to me or their patients. They simply cannot afford any emotional connections with us. Imagine that, most of us come with high hope and go with great sadness. How can they be happy seeing our dumping all the money to the drain... I understand now also why the REs seem to be always hiding from us. They stay behind the scene, just check our charts and give orders based on what they read from the blood work and sono graphic reports. In this case, they can get their job done. Otherwise, they could be eaten alive consumed by their angry or emotional patients! They know keenly that most of their patients cannot afford multiple ivf cycles yet ironically a live baby almost always requires multiple ivf cycles. I had naively believed that all I needed was ONE ivf cycle, which was also predicted by my ob/gyn. She liked my low FSH (follicle stimulating hormone) and she liked the fact that I was pregnant before (at age 24). But now, I was already at my third cycle.

Okay, back to my cycle. Everything looked perfect this time so far. At march 20th, 2006, 38 days from the start of the cycle, I was back to the clinic, for the third time of this frozen cycle. The E2 rose a lot (263) and endometrium grew close to 8 mm's thick. "This time will work." I thought. "Take 2 mg estrogen pill per night and come back again three days later." I was sent home and wait. Apparently, they wanted thicker endometrium and higher estrogen level. Three days later, on March 23rd, the E2 rose to 414 and I was told good enough, the embryo transfer (ET) could be scheduled. Yahoo!!!

To prepare the ET, one needs to take antibiotics and immune suppressants (tetracycline and methyl prednisolone, in my case) for few days to prevent infection and immune rejection of the incoming embryos. And one also needs to take progesterone in oil (PIO) shots, which is the most scary and awful hormone among all the other hormones for ivf cycles, because others ones need only subcutaneous injections with tiny insulin needles, you can hardly feel them. Yet PIO requires intramuscular injections with long (1 and 1/2 inches) and big needles, 18 gauge (G) ones for drawing out the medication and 22G ones for injections. Unlucky for me, the local pharmacist from whom I often got my medications ran out 22G needles, so he sent me home with bunch of 20G needles. "Draw and inject PIO with the same needle and push all the way inside of the top quarter of your buttock." the pharmacist instructed. Those were some scary looking needles. At the first, I asked Fabrice who does intracardiac injections in the lab often to his experimental subjects (rats and mice) to perform this horrible task. As masculine as any man in the world can be, he could not inject his wife with these long and scary needles. Now you know why surgeons usually do not operate their own wife and kids. After two painful injections that Fabrice did on me, I took over. I was tired of pretending that did not hurt. That hurt like hell! Progressively though, I learned how to look at mirror to find a good spot, I learned how to twist my body to give myself a shot on the top of my butt, I also learned how to find new locations and then rotate from left side to right side of my buttock, from left thigh to right thigh to avoid forming lumps at those injection sites.

The ET was scheduled on March 30th, 2006. Two days before the ET, the embryologist thawed 6 precious embryos, 5 of which survived and thrived to become 5- to 10-cell morulas after two days in the incubator. The quality of them were great, as I was told. On the day of ET, my RE sat Fabrice and me down. He told us that he planned to transfer all 5 back into my uterus. "5?" Fabrice and I were shocked. "What if they all implanted?" we both questioned. The RE patiently explained to us that he had not experienced many multiple pregnancies in his practice with 43-year old eggs. "Not every 43-year old woman can make 24 eggs at each ivf cycle, either." I reminded him as if he had not been the one who had read my chart every day and directed the whole process. "Plus, we had a friend that she had to do selective reduction to sacrifice two implanted embryos. She had transferred 3, but one of which divided and separated to become two." I naively argued with a white lie - I only heard this story from our MD friend who likes to exaggerate to make his point. He suggested us not to transfer more than 2 embryos the day before our ET day, when we asked him how many we should put back.

Having sensed it would have been a total waste of time to continue this discussion, my RE said, "If I were you, I would at least transfer 4 of them. We could leave the 10-cell embryo out since in our experience, fast growing embryos rarely give rise to live babies."... "you think about it." Then he left the room to get himself preped. Fabrice and I looked at each other and it did not take that much of a discussion for us to decide to listen to the man who was doing this everyday for the last decades. When the RE returned, both Fabrice and I answered simultaneously "Four" to his questions of "how many have we decided on?" And then we (mainly, I) spent the next of the two weeks worrying about multiple pregnancies.

The ET process was bit of nerve wracking, since it almost did not happen. Because my RE almost lost them in the air! When the embryologist brought in my embryos in a petri dish, she announced, "We are going to transfer the following 4 embryos: 1 at 8A, 2 at 6B, and 1 at 5B." Meaning one grade A embryo of 8-cells, 2 grade B embryos of 6 cells, and so on. Then she went back to load them into a thin and long plastic tube (catheter) and handed the catheter to the RE. The RE somehow did not hold the top of catheter tight enough, that top is important since it prevents the embryos inside the catheter to leak out! I saw one small drop of liquid (medium) at the tip of the catheter. He saw that too, so he handed the catheter back to the embryologist. She left the ET room to the embryo lab next door and returned promptly. I guess she had checked it under the microscope to make sure none of those precious embryos escaped along with the medium. So, the RE proceeded to send my precious embryos inside of my uterus through the catheter, with the help of the ultrasound machine. It took sometime for him to push them one by one out of the catheter. The room was quiet, we all held our breath and stared at the ultrasound screen. Then the handed the catheter back to the embryologist. She left and came back again promptly. I guess she went to examine whether all the embryos were out. I remember seeing she handed the catheter back to the RE, but I could be wrong. What I do remember was that I was not too impressed by my RE. I remember thinking that he was not young enough to have a pair of steady and meticulous hands for such sophisticated procedure.

I had done ivf and ET with my own hands in the lab to my poor subjects, mice, a while ago prior to my own ivf cycles. I knew that it could be very difficult to get those embryos inside the catheter - they float in the growth medium and I always worried about hurting them, even though I knew it took a lot to actually damage them since the medium protects them from mechanical damage. When we load them into a catheter, we also load a bit of medium in between each embryo so that we can easily control the transferring process. One must have steady hands for this job. Otherwise, the embryos could be lost in the half way! Let's assume this did not happen in my case, shall we?

On April 5th or one week after the ET, I came back to the clinic to get blood work done and was told later on that day that my E2 was 385 and P4 was 42. I did not know what that mean. I was told that just to make sure that my E2 patches and P4 (PIO) work well. In some of the ivf clinics, this mid-term check is omitted.

I did home pregnancy test (HPT) every other day after that. And at day 12, on April 12th, 2006, just before I went to the clinic to have the blood drawn for the official pregnancy test, a faint positive line showed up in the HPT stick, which I picked up at CVS store on the way home from work the night before. I was excited and told the phlebotomist confidently, "I saw a faint line on the HPT this morning." "Oh, good," she answered indifferently. She must have heard that a lot, I thought. "Is it often that a urine HPT tells you positive but blood test tells negative?" I pushed my luck. "No, it usually is the other way around. Blood test is more sensitive and accurate." she answered, reluctantly. Then she gave me the signal to leave so that she could move on to the next person in line. 

In the early afternoon on the pregnancy test day, a nurse with lovely voice from the clinic called me at work. She informed me the pregnancy test was negative. A dreadful BFN (big fat negative)! "What was the number?" I asked her, pretending that I did not hear what she said. "Zero." She answered. "What, not even a chemical pregnancy? Why the HPT showed a positive line? Where could those embryos go?" I asked as if she did not know what she was talking about. "A negative is a negative, there was nothing vague about it. I am so sorry." she must have said she was sorry many times. She sounded very sincere and sympathetic so I trusted that she was sorry. "Oh, don't apologize, you must have done this job for sometime now and I am sorry for you instead for having to break people's heart more often than you would like to." I sounded like her boss, I guess. It was the very first time that I was formally informed to have a negative pregnancy test. To be honest, I was not nearly as devastated as I later became at that moment. I did not know what I was doing, but I was sure that I felt sincerely sorry for the nurse who had to call me for such disappointing news. It must have also been the very first time that she heard someone who said sorry back to her, since I had not heard her speaking until a good a minute or two later. "Please make sure that you stop all the meds and wait for the next period. And oh, do not have intercourse before your next period!" 

For the third time, I was told to stop all the medications to wait for my next period to call the office back to arrange for the next cycle.

The faint line is a line, there was nothing vague about that. That would at least suggested few picorgrams of the pregnancy hormone, HCG (Human Chorionic Gonadotropin) in my urine. Maybe the pregnant test that the clinic used was not sensitive enough to detect so low level of HCG! I told myself and continued few more days of the progesterone and HPT. I did not believe the hospital pregnancy test. It was the first time that my ivf cycle went far enough to finish a cycle. It was the first time that I had few embryos transferred back to me. I could not give up so quickly. 

I was clearly in denial, because the line I saw the other day disappeared mysteriously, no matter from which direction that looked. My period showed up at the exact predicted day, April 18th, 2006, 6 days after the pregnancy test, one day after I ran out of the progesterone suppositories. I failed once again, spectacularly!
Stay tuned, in my next post, I will tell you how to cope with ivf failures. Just between you, my dear hidden readers, and me, those techniques guarantee you a live baby! 

Thursday, August 18, 2011

IVF Journey - Part II, frozen cycle I

With 19 embryos frozen, safe and sound, Fabrice and I both believed that in two months, I would be pregnant, which would mean it would be out of question to travel by the two of us alone. So, we made a last minute decision to go France, just the two of us, for the last time before we would be tied up by parenting duties. Plus, none of my previous visits to France was in the Winter, it would be nice to spend a real Christmas in France with the family, I reasoned. Most importantly, this trip could make the 2 months of waiting so much faster!

In the early morning of Christmas Eve, we landed in Paris. After 1.5 hours TGV ride, we arrived Burgundy, Fabrice's hometown, just before the most important meal of the year. Andre, our brother-in-law, and French professional chef prepared the most wonderful dinner for the family. It had millions of courses and thousand kinds of wine. After getting ourselves stuffed and drunk, the whole family gathered in front of the fireplace to wait for the Santa to deliver his gifts to us all. Santa showed up few minutes after Fabrice mysteriously disappeared from the crowd. Then one package after another showed up. We had a lot of fun unwrapping and watching Didier, Fabrice's nephew who was only a bit older than 2 years old at that time, going in and out of his gift boxes. Like all other kids of that age, Didier was far more interested in the gift boxes than the gifts themselves. Soon, the question natually popped out, everyone wanted to know whether Fabrice and I were making babies. He said, yes, yes, avoiding the details.

Two days after Christmas, we left the happy family and went to the famous Alps with Pierre and his girlfriend. Pierre and Fabrice were friends since middle school and he and I had become close friends over the years since we met the first time at Dijon. The four of us spent a whole week in a beautiful village 1 mile from the top a ski resort (got to find out the name of that lovely village and the beautiful ski resort, come back to check later, if you are interested in them). We skied in the day and swam or skated in the night. We cerebrated the New Year's Eve in the Alps with locally produced cheese and wine... The trip was sensational. It was so wonderful that almost led me to forgetting our frozen embryos.

But it did not. When the period showed up together with the year of 2006, I called the clinic from the Alps to leave a message to my clinic in the U.S.. The clinic was closed at that time, I simply just left a message to let them know that I knew what I was doing - start to take birth control pills (BCP) the next day until finish the 21 green pills. Few hours later, Fabrice's french cell phone rang, I was pleasantly surprised that my clinic called me back to make sure I knew what I was doing. She said that she got our French phone number from their modernized answer machine!

This was a good sign, I thought. It would be a lucky cycle: new year, new start with new hope, and a very caring nurse!

An ivf frozen cycle is much simpler than our first one. All I needed to do was to take BCP for 21 days and then the Lupron for few more days to beat the ovaries to death. After that, use E2 patches - estrogen hormone on a plastic sheet, so that the E2 can penetrate the skin and follow your bloodstream to the uterus to stimulate the endometrium to grow to 8~10 mm. This will make the endometrium thick and warm to accept the incoming embryos.

At the end of BCP, follicle sized at 4.8 mm and E2 equaled 0. I was okayed to proceed with Lupron injection. In the end of the Lupron, I was told to put on one E2 patches (0.1 mg). However, at next check up, the follicle grew to 4.2 mm and E2 rose to 90. The nurse did not find anything abnormal although the E2 level looked a bit high. She then wanted me to stay on Lupron for another week in the mean time of continuing the E2 patches of 0.3 mg. 7 days later, however, two follicles of 14 mm and 9.2 mm were found by sonogram and the E2 rose further to 124. "We have to abort this cycle." I was told once again.

Until today I could not understand why I had to abort that cycle. In my humble opinion, they could have done the ET to match with my natural cycle!

This second cycle's fate was "cancellation due to dominant egg". Nobody knew what went wrong. Later I discovered that could be due to the fact that the that I used was diluted leftover Lupron from the mini-dose flare cycle!

Regardless, my second cycle was aborted and my uterus was still empty. Two ivf cycles later, none of our 19 embryos was transferred back to where they should be. I was once again instructed not to have any sex until further notice and stop all the meds to wait for the egg to go away with my next period.

I became a bit of anxious now: what if the liquid nitrogen tank had electricity failure. What if the liquid nitrogen was not filled properly. What if they accidentally thawed my embryos to transfer into another woman? What if the clinic was on fire... One cycle (two months) delay sounds like nothing to most people, but to a 43 going on 44 years old woman, this wait was like infinity.

Tuesday, August 9, 2011

IVF Journey - Part I, first cycle

IVF or in vitro fertilization, is one of the most effective ARTs (assisted reproductive technology) that many infertile couples or fertile women at advanced age rely on to get themselves pregnant nowadays. If you are trying to conceive but not able to in a year or two, you may know exactly what I am talking about here.  I belong to one of the these normal women who is fertile when young but infertile when aged.  I don't really know when I had become infertile.  What I know for sure is that I used to be fertile at age of 24.  I also know that my mother had my little brother at age of 40, although that was the third child my mother had.  I discovered painfully that I was too old to get myself a baby or two at age of 43 and started to go through ivf process in last quarter of 2005.

At the first try, we, like many other ivf newbies, were quite confident and optimistic.  The reproductive endocrinologist (RE) had us started right away since I was very close to the cut-off age - the clinic we went does not take any woman who is older than 44 if she wishes to use her own eggs.  So, I was instructed to get started immediately.  The protocol that my RE used on me was the most effective one for women of advanced age called mini-dose flare protocol, which involves taking regular birth control pills (BCP) for 14 to 21 days - depending on where you are at your cycle - to make sure that the ovaries don't produce any eggs.  Following this so-called suppression period is a flare stage, which involves to take mini dose lupron to jump start the ovaries.  After 3 days of lupron, one needs to take FSH (follicle stimulation hormone) to stimulate follicles (eggs) to grow in the mean time of continuing the mini-dose lupron for entire course of FSH stimulation, which lasts 7 to 10 days, depending on how fast your eggs become mature.  Just in case some of my readers here are from the ivf message boards or undergoing ivf at the moment, here is the detailed protocol and progress in my first and the only ivf fresh cycle:

10/17/05 ~ 10/31/05: BCP, for 14 days

11/4/05: E2 = 23, egg = 3.5 mm
8 pm, Lupron, day 1, 20 U (diluted, 50 mcg/ml, 0.2 ml)

11/5/05 ~ 11/7/05:
8 am, Gonal F (FSH), 300 U + 20 U Lupron
8 pm, Repronex (75 IU FSH and 75 IU LH per vial), 2 vails + Lupron, 20 U

11/8/05: E2 = 706, eggs = L10 + R15, 7.7 mm
8 am, Gonal F (FSH), 300 U + 20 U Lupron
8 pm, Repronex (75 IU FSH and 75 IU LH per vial), 1 vail + Lupron, 20 U

8 am, Gonal F (FSH), 225 U + 20 U Lupron
8 pm, Repronex (75 IU FSH and 75 IU LH per vial), 2 vails (a mistake, was told to use only 1 vail) + Lupron, 20 U

11/10/05: E2 = 2344, Eggs = L14 + R11, 9.6 mm
8 am, Gonal F (FSH), 225 U + Lupron, 20 U
8 pm, Repronex (75 IU FSH and 75 IU LH per vial), 1 vail + Lupron, 20 U

8 am, Gonal F (FSH), 150 U + Lupron, 20 U
8 pm, Repronex (75 IU FSH and 75 IU LH per vial), 1 vail + Lupron, 20 U

11/12/05: E2 = 3000, eggs = L18 + R18, 11.2 mm
8 am, Gonal F (FSH), 75 U + Lupron, 20 U
8 pm, Repronex (75 IU FSH and 75 IU LH per vial), 1 vail + Lupron, 20 U

11/13/05: E2 = 6328
8 am, Repronex (75 IU FSH and 75 IU LH per vial), 1 vail + Lupron, 20 U
9 am, HCG, 5000 U
8 pm, Lupron, 20 U

11/14/05: E2 = 6772; HCG = 156
8 am, Lupron, 20 U
8 pm, Lupron, 20 U

12 pm, egg retrieval, 24 mature eggs collected.

No transfer due to hyperstimulation!

As you can see, this mini-dose flare protocol worked extremely well.

During ultrasound exams, I found many black holes in my ovaries.  They looked like a grape bunch and those grape-looking follicles were becoming bigger and bigger with time.  The ultrasound technician carefully measured the sizes of each of them and then reported to my nurse, who was quite happy at first, then she became less happy and finally nervous.  Of course, she tried her best to hide her emotions, but my professional sensitivities allowed me to detect her panicking state of mind.  At the 4th day into FSH, I was told to decrease the FSH dose, two days after that, I was told again to decrease the dose even more!  My crazily growing follicles seemed to become more and more of a concern than of an excitement!  I did not know why the nurse was nervous at all, because I thought the more follicles, the better.  The increased number of growing follicles also raised the estrogen (E2) level in my blood stream, which caused severe fluid retention.  My lower abdomen felt very bloated but I did not know it was fluid retention - a side effect of high estrogen!  I was jogging every other day for 5K each time!  I could have died from stroke!

At the day of egg retrieval (ER), Fabrice was sent to a small room to make his contribution to the baby producing process.  After a short while, he came out and handed a brown bag to the nurse, who was waiting outside with me then she immediately disappeared from our sight after receiving the brown bag.  She must have gone to store the bag in a cold and safe place because inside that bag hiding a plastic cup filled with Fabrice's little swimmers.  "That was quick, did they allow you to watch pornographic movies in there?" I joked to Fabrice once we were left alone.  He gave me an evil look and said, "I wish."  Later that day, he told me he was seriously thinking to suggest the clinic to make some effort so that small sperm-collection room could be more exciting.  I wanted to be sarcastic but I could not since I was quite sympathetic of him.  I have to admit even though that was the only contribution he had to make in this whole ivf business, I would not have traded anything I have done for that 1 minute or two that he had to spend in that room.  I could not imagine how awkward that he must have felt while being confined within a strange and small room masturbating.  Yuck!

After that, Fabrice followed me into the ER room.  I was drugged up with an by someone who looked familiar but I could not recall where I saw her before - Few days later I met her again in the same building, I suddenly remembered that she was the same anesthesiologist who knocked me off few months ago for my ob/gyn who was performing laparoscopy to find out what happened to my female organs then - The RE was chatting and asking how I felt. Then slowly I could not hear him anymore. It felt like merely seconds later I woke up, I heard that the nurse was telling me that the RE collected total of 24 mature and beautiful eggs excitingly. I, on the other hand, was not exciting nor happy because I was expecting 36 or so. So, I asked, where were the rest of these eggs? "Oh, the RE was too exhausted to collect them all since they were still small." REs usually collect as many eggs as possible if ivfers do not produce enough eggs since they can mature them in the incubator. But in my case, there was no need to go this route. The nurse then hand us some instructions and told us to wait for another 15 min to leave. On our way out, the RE stopped us and told us that the sperms were being prepared (washed, centrifuged, cleaned?) and they would check the quality and quantity. If more sperms needed, they would call, he said to Fabrice. "my office is right across the street and just call me." Fabrice showed, for the first time from the start of our ivf cycle, some enthusiasm. 

However, we did not receive any phone that afternoon, nor next morning. Everything must have been fine, Fabrice told me, when I was bugging him with all my suspicions. The Clinic finally called in the next afternoon. "We have some good news." She said. I knew it. Something must have been terribly wrong. Because of it was only good news, she would not start her conversation like this. None of my eggs were fertilized? Survived? I started to imagine the worst scenario. "The good news is that 20 out of the 24 eggs matured and fertilized well and 19 grew to 2-cell stage." "Wow, that sounds very good. I am do glad that you had enough sperms for the in vitro fertilization." I said to her with some kind of suspicious tone. "Oh no, we had to do ICSI (intracytoplasmic sperm injection)." She told me but this made me upset, because that would cost us additional $1000! "Why did not you call to ask my husband for more sperms! We were just here waiting for your call." Now I was bit upset that our clinic did not keep us informed and did a procedure without our consent. She probably gave me tons of reasons to explain why ICSI was necessary, but I was worried about that did not select the best quality sperms ti do the job. Based on what I learned from text book, only the strongest and healthiest sperms can make their long journey to meet and enter the egg. How could they omit this important natural selection step? "Oh, ICSI has better fertilization rate." She explained.

I am sure she said something more, but whatever she said, it did not matter anymore. Finally, she continue to tell me what I did not like to hear, "The bad news is that you now need to stop all the medications and wait for next cycle to call us back." "What, why?" I asked her to repeat and made sure what I heard. "I won't come back tomorrow for the embryo transfer?" I asked. "No, just stop all the medication. And it is important that you and your husband won't have intercourse in the next few days."  I was so upset for not being able to continue the ET step and must have been shouting in my end at this point. "Your have 19 good quality embryos, don't worry." She tried to calm me down. She explained to me that the estrogen level in my blood was too high, which was a indication of over-stimulation. If we proceed the next ET (embryo transfer) step, I would have a high risk of OHSS (ovarian hyperstimulation syndrome). I did not want to listen to her for all these reasons. I argued, complained, and begged that she would talk to the REs and let me come back for the next step. "But all your embryos have already been kept frozen." She tried to end the long conversation. "What will it be next cycle?" I asked with disappointing tone. "Sometime next January." She said. I could not believe my ears. Now, I was very upset. Not only I could not proceed for the next step, but also I had to wait for longer than expected. "We would not have enough time to start and finish your next cycle, since we will close in week of Thanksgiving and 20 days of Christmas and New Year." I was speechless, I was shocked. I never knew that Americans had real holidays for more than a long weekend, let alone it was 20 days!

That was a long phone call and possibly the most difficult phone call my nurse had to make on that day, if not in her entire nursing life. I thought that I reached the end of the world. I had to let her know how I felt until I finally realized that she was merely doing her job as my nurse. She was not paid as my psychiatrist. "Okay, I will call you when my January cycle comes." I let her go on her life, finally.

I am not an easy customer. I admit. I demand every penny's worth of service. 

The next of the few weeks, I sent my lovely husband Fabrice to hell and I will tell you how in my few posts. Stay tuned!

Monday, August 1, 2011

My imperfect father - Part III, the stroke

According to my father, there is no need for doctors. His teases everyone who believes in doctors, "why go to see doctors? For serious diseases, they cannot cure, yet for general problems, we don't need them." When people fall ill, he says to them, "Drink water, plenty water. It is the best medicine!" It is with this belief that he rarely goes to see real doctors. I said "real" because in China, doctors in hospitals are usually the real ones who see patients. My father does not go to see those in the hospital, he goes to see the ones in a small clinic that is owned by the place at which he used to work before his retirement. The "doctor(s)" in such unit-owned clinics are so out of practice that they can hardly make any true diagnosis. Their job mainly is to hand out cheap medications to people in need. Unfortunately, when it comes to hypertension, cheap medicines may not do the trick and my father recently found this out with a great price.

In early September last year, I received a suspicious email from my young stepmother Hui. "Father fell few days ago. He had a bit of hematoma on the forehead above the right eye but it is mostly gone. He is in the hospital now but nothing is serious, don't worry". Hui never writes me email in her own voice, she only sends me emails from time to time in my father's tone - he dictates and she writes. I smelled things must have been more serious than sounded. A simple fall would not require hospital stay, especially for my father. I made my intercontinental phone call at once and got my older brother Bing who was at the hospital taking care of the old man. Bing told me that a few days ago, our father got up with a bit of dizziness but he did not pay too much attention since he had experienced such dizziness before. He went ahead for his routine morning exercise. Just few steps outside the main gate of the residence, he fainted and hit a stone. Fortunately, he was sent to the hospital immediately and he was fine now. "The doctor found a small leak in the brain blood vessel, which was caused by the high blood pressure and led to the fainting. The bleeding is under control now." Bing said.

I called everyday in the next few days monitoring the recovery process. My father's could speak through the phone to me, although his voice was very weak and barely audible at the first, but it progressively became louder and clearer from one call to the next. Soon, he sounded like a normal, healthy, and strong father who I knew again. "We are going home next week." He told me confidently. The doctors told him as soon as he could stand up on his feet to walk few steps, he could go home, since his blood pressure was already under control with the new medication that they prescribed him. "We are expecting a full recovery." The doctors told my father. They were optimistic.

True, I trusted the doctors based on the amazing clarity and strength in my father's voice when I talked to him on the phone. It improved so much in just few days. It's just the matter of time now to have him walk again, I believed. I felt safe and went to a conference in Canada. The conference was intense, I did not call my father until I returned to the U.S. 6 days later.

"He lost memory, could not recognized Hui, me, or anyone any more." Bing told me this when I called. I asked to talk to my father, Bing said, "He has not opened his eyes in the last two days. He has not had much food lately." I was in disbelieve. His condition had gotten much worse. It was not at all the direction it should go. "What went wrong?" I demanded to know. "We don't exactly know. We are transferring him to GXMU today." my brother said. That was not a good sign because that meant the current hospital was good enough for his condition. "MRI revealed a big hole in the center of the brain." Bing continued, "The doctor thought there was a clot blocked the fluid in the brain to circulate. The clot could be caused by the anticoagulant used earlier to stop his bleeding." He tried very hard to control his fear of the worst consequence. "The hole (hydrocephalus) had been seen before but we thought it had been resolved since father had seemed so much better. However, it has a size of an apple now."

Bing is usually a calm and confident person. He is the oldest among us three siblings and the only one currently living close to our father. He had been taking care of the old man for a whole month now by sleeping/resting in a chair besides our father's hospital bed every single night ever since the stroke. When he goes to work in the day, Hui, the wife of my father, was taking over since she does not have a job anymore, she quited her job in order to accompany my father to come to the U.S. in the end of 2009. My younger brother YH was/is living in Xingjiang province, which is 36 hours plane and train ride away. Bing did not let us know our father's stroke at beginning since he did not want to worry us. The situation now was different.

"I am coming back home." I said. I was worried to death. GXMU is the best in town and it is the same hospital at which my mother lived in and out for 4 years and then eventually died 24 years ago. I started to imagine that my father was dying there soon. I needed go home immediately to see him for the last time.

Later Bing told me that he had noticed that my father's condition took a turn from okay to bad, because his dizziness had not gone away and he could never stood up on his feet without assistance. He had looked for new doctors in GXMU before but was not in any big hurry to move my father since my father was treated like a King in the current hospital. First of all, people in his rank don't usually come to this hospital. Second and most importantly, the head of this hospital is my little sister-in-law's father. He came by to check on our daddy frequently. It was him who had helped Bing to transfer the old man to GXMU once he found a bigger hole in his brain.

By the time my father arrived the new hospital, he had lost consciousness completely and was directly admitted to the neurological ICU. New doctors seemed great, they told Bing the doctors in the previous hospital did everything correctly. The big hole in the brain indeed was excess CSF (cerebrospinal fluid) and it needed immediate attention - "It had to be drained surgically." They told Bing. They offered few options, such as to drill a tiny hole in the skull to drain the CSF outside. But this wouldn't last. If the clot could not be resolved after that, the CSF would build up again. Another was to put in a shunt to drain the excess CSF from the brain to the belly. The shunt would remain inside of my father and it would function whenever needed to. My brother thought this latter choice was more sensible. But the doctors thought it could be too invasive to someone of my father's age. "He is already 79 years old, you need to decide whether this surgery is necessary." The doctor told Bing. "What are you suggesting, do you have other better ways to save his life?" Bing began to be upset by the coldness of the neurosurgeon. Seeing my older brother was so determined to save the old man's life, the surgeon agreed to schedule his surgery as soon as my father's general health condition was confirmed to be able to sustain such a procedure. "It might take a few days for us to schedule him." The surgeon said. "Could it be sooner, the old man could die anytime from now!" Bing was desperate and angry at this point. The surgeon did not seem to be willing to negotiate. "Well. your father is not the only patient in this hospital. Plus, we will have to check his heart, kidney and other vital organs to make sure there won't be any surprises."

After ending the phone with my brother, I called the Continental and booked my ticket right away and then I called back to tell Hui and Bing my detailed itinerary.

"We were told to get ready for Daddy's surgery, the first thing tomorrow morning,!" My brother was excited to inform me. "What? did you bribe him?!" I was certain that he finally caved. The longer we waited, the more damage the CSF would do to the neurons inside my father's skull. "No, your sister-in-law called someone." Bing told me. That someone called someone else. And that someone else finally reached the very top of the hospital and then the top person told the neurosurgeon that this patient (my father) could not die. If that had happened, he (the surgeon) would be fully responsible.

I am sure the details are a bit different. Because my little sister-in-law's father, the head of another hospital, was also calling everywhere to help in the same time. Although he was out of town for a business trip then, his connections just a phone call away. I believe the surgeon may have received pressure from multiple sources. I also would like to believe that moving my father's surgery ahead was a medical necessity not just a simple result of these phone calls. The surgeon should have made this decision at the begin with.

"The neurosurgeon obviously was trying to make me pay him extra money." Bing said this to me when he was on his way to meet the surgeon to go over the details of the procedure next morning. "Why do you say that?" "Well, otherwise, why did he ask me what do I do for living? He must have wanted to know whether I have the means to pay him." "Or he wanted to know why you suddenly could get so many people to give him order." I offered different explanation since I imagined the surgeon must have been annoyed by those phone calls that he had received. "I would have reported him if he had delayed father procedure." Bing said to me angrily. He had not changed a bit. My brother Bing was a very successful computer engineer/businessman in early 90s. He belonged to the first generation of rich people in China. It was him who paid my first semester's tuition for my graduate study 19 years ago when I first arrived the U. S.. Unfortunately, his richness was short lived because he refused to follow the "codes" - he did not bribe anyone above him at work and he also had not taken any money from his customers, while most of the others did both. "Give the money to sister-in-law and let her give it to the surgeon after he is out of the operation room." I tried to persuade him. He did not answer me directly. "Ok, I am at the hospital now, the surgeon will come soon. Call back later." He was going hang up. "Could you please leave the line open so that I can hear what the surgeon has to say?" I begged and Bing agreed.

Love the modern technology.

The surgeon sounded quite neutral and objective to me. After explaining what kind of a procedure it was and how it was done, the surgeon said to Bing, "As I said before, nothing is guaranteed. He may or may not recover completely after the surgery. Given your father's age, we cannot promise anything." He then asked Bing to choose which type of shunt to use. "Some of them need to be paid by the patient, regardless which type of insurance policy the patients have." The doctor said. "Choose the best you think it's necessary." My brother Bing answered quickly with the clear willingness to donate one of his kidneys.

The surgeon might have left soon after that to get the procedure started. Bing said to me, "The surgery is going to be finished by the end of today and your coming back now may not help that much." Bing was right. It would have been a big hassle for me since it would be just 20 days away from our scheduled vacation to China. My husband Fabrice and I had already planed this trip long ago. If I went home now, that would mean I would have needed to fly back to the U.S. again to get the kids in two weeks. "Should we hold our trip to China this year?" Fabrice asked carefully when he saw me torn by the dilemma. He was also worried about if my father had passed away, it would not be a good idea to have the kids home only to experience the sadness.

I have to admit that I was not at all ready to accept the fact that my father, a strong and healthy man who was just here a year ago living with us for 4 months, would die anytime soon. To calm myself down, I consulted a neurosurgeon in Fabrice's swimming team. "The surgery itself is simple, safe and the best way to reverse the situation." The neurosurgeon told me. He was still in his swimming trunk; I caught him right after his swimming training on the Saturday morning. "Clearly, the facts that your father is 80 year old and in ICU now indicate that his risk is quite high." He was not willing to advice me whether I should go back to China immediately. But it was important for me to know from an expert in the U.S., a country has best medical doctors in the world, that he was confident that our Chinese surgeons had made best treatment plan for my father.

After that, I decided to call my cousin, who is the family member that I can rely on in such situations. She echoed Bing. So, I decided to take the chance and trust my instinct. My cousin and brother were right, I would have missed him anyway if he would have not survived the operation. "Okay, I will cancel today's ticket to China." I told my older brother and Hui both, "Please tell Daddy that ZhuZhu and NiuNiu are on their way to see him."  Hui was then living full time in the hospital with my father ever since he was transferred to the new hospital. I was wishing that my Daddy would hold himself for his two lovely grandchildren. "Be sure to show him the photos of ZhuZhu and NiuNiu when he wakes up." I begged them.

The next week following the surgery was the slowest days of my life. We were told that the surgery went very smoothly and my father survived. Bing, Hui, my two sisters-in-laws, my father's youngest brother and his oldest son who came that very day from Hunan province were all anxiously waiting outside the OR. But they were asked to go home staying by the phone after the surgery. "We will let you know when you can come back to visit him." The surgeon said. My father was in critical condition and would be wheeled back to the ICU after a stop by MRI. At that point, only trained nurses could go in the room. He turned to Bing and my cousin (my uncle's son) that they could follow the nurse to get the MRI done since they may help to move him.

The hospital's phone call was delivered to Hui 18 long hours later. She needed to change her cloth and wear protective masks to avoid bringing bacteria to the ICU room. "He was in his deep sleep. I did not wake him." Hui told me. Bing and sisters-in-laws were also allowed to see him later that day, but only few minutes per person and one person at a time. They said that my father could open his eyes, move his lips, but no sound, still. Two days later, he could eat tiny amount of liquid food. Three days after, he was transferred from the neurological ICU to cardiovascular ICU. The doctors allowed him to stay in N-ICU longer than regular patients because he was then with a new label as an important figure. The cardiovascular ICU was not medically justified. The nurses told Hui. But regular hospital rooms don't provided specially trained nurses, the hospital allowed him to stay few more days there, just in case.

It turned out that our Chinese doctors did a great job in saving my father's life. My father slowly gained his senses. He even could tell stories to his visitors few days after he was out of the N-ICU. "He made up a lot of childhood stories. He also told us that his youngest son was in a farm in Beijing to grow cottons." Hui told me. My little sister-in-law said, "Daddy said 1+1 equals 5." She is an elementary school art teacher who likes to tease the old man. Her job was to teach him simple maths. About a week after the surgery, I heard my father's voice again on the phone, although he could not tell who I was at that time. I put ZhuZhu and NiuNiu on the phone and he was very excited hearing them calling him "Lao Yie (grandpa in Chinese)". However, he did not remember their names.

Three weeks after the surgery while everyone in the U.S. cerebrating their Thanksgiving holidays, our little family of 4 showed up in front of my father in China. He was lying in the bed, peacefully. We did not want to wake him, but he heard us and opened his eyes, slightly. It was 1 a.m. and we retreated soon after the quick stop by. Next morning we came back, he was already cleaned and lifted to a sitting position trying to eat his food in bed. He had not gained back his appetite for food yet. He looked much older than he had been a year ago while in the U.S.. He lost tons of weight and his legs became two sticks wrapped in a dry skin. Hui told us the details of their adventures in the last few weeks, "We have moved from neurological ICU to cardiovascular ICU, then to regular hospital room (two patients per room) and finally this luxury suite in the hospital rehab center." I was so used to the U.S. hospital rooms that did not even notice how "luxury" the suite was! It is huge and has one bed for the patient, one sofa bed for one family caretaker (Hui), a shower and a toilet room, a TV, a dinning table, two quest chairs, a large and tall dresser, a night stand. These rehab rooms are not open to general population, as you can easily imagine. If it was not my sister-in-law's connection or his social ranking (we don't know which one was more important), my father would have been sent home to recover all by himself.

So our vacation to China in 2010 was spent mostly in a rehab center to witness my 79 year old father transforming from a zombie a semi-healthy person. He went back home the second day after we left China to the U.S. to continue to learn how to walk by himself. The little ones did not know what grandpa was doing in the bed all the time, but both of them loved running in the corridor of the rehab center. The hospital doctors and nurses were thrilled to have these two little hybrids showing up energetically every morning. If one day we came late, they would come to ask my father when we were coming. The doctors even spoke to Fabrice in English whenever he was in the room. They had become a family! ZhuZhu occasionally would ask Lao Yie to go home with her, but NiuNiu always requested him to go back to sleep. "Do Do, (sleep in French), Lao Yie!" He commanded each time Lao Yie was practicing his walk in the hallway.

My father spent more than 3 months in the hospital. He survived. "The only thing bothers me now," he said to me, "is the shunt that I am carrying. I was not born with this tube and I want to get rid of it."

It's almost a year ago since my father had his stroke. Knock on wood that he won't have another one any time soon. He is now able to walk in quite a distance without any assitance. He also can talk and argue with people, two things he enjoyed the most. Thanks to the neurosurgeon and the medical advances, we are enjoying having him back! . 

"I started to write a book. I dictate and Hui is typing for me." He said to me last time when I called. I requested him to write about his childhood stories. I also asked him to write about my childhood stories. I need these stories so that I can tell them to ZhuZhu and NiuNiu. He no longer can hold a pen steadily to write. This may not be a problem for many other 79 year old man. But for him, a pen was his best friend and sharpest weapon. Although a stroke did not cripple him, it certainly ended his ability to write with his own hands.

P.S., Bing finally gave 3000 yuan to thank the surgeon few days after the surgery. He said that was his first and hopefully last "misconduct". I confess that I pushed hard for this since our Chinese doctors are not nearly as well paid as American ones.