Fertility: A Novel (13 page)

“Nah, no point. He’s long gone. And I’m okay, really,” she said, touched by Rick’s response.

“You know, when and if you ever want kids, the docs may be able to help you,” he said. “They’ve come a long way with IVF — in-vitro fertilization. You’re young and otherwise healthy. But I warn you, you may end up with more than you bargained for — triplets, for example. Really, Sarah, you may be able to become a mother if that’s something you want.”

“You think? Well, it’s always nice to have options. I didn’t take it well when my reproductive life was extinguished at the age of twenty-three.”

“Are you sure your tubes are blocked? Sometimes they’re partially occluded but those little spermies don’t need a heck of a lot of room,” Rick said, trying to make certain there would be no need for them to take precautions.

“Well, two eminent gynecologists feel certain. And I went for a couple of years in a subsequent relationship without using any birth control. I have no children hidden under the couch. Promise.”

“No babies under the couch?” Rick ducked down and took a look, bringing a little smile to Sarah’s somber face. “You speak the truth,” he said. “No babies under the couch. Okay. So we’ll get tested and then — if it’s all right with you — we’ll say good-bye to the condoms.”

Sarah caught his gaze and held it. “Sure. But there’s one more thing. I’m assuming that you’re suggesting we ditch the condoms because you want us to be exclusive. And that’s fine with me. And it will be fine until it’s not fine with one or the other of us. What I mean is, when you want to be with someone else, just tell me. And I promise I’ll be frank and honest with you, too. We’re grown-ups. When we’re not enjoying each other as we are now, or when something else catches your eye or mine, well, no game playing. Okay?”

Rick was having trouble imagining a time when he wouldn’t want to make love to this woman, to run along the river with her lithe figure next to his. For Sarah, he’d willingly drop out of the hunt, for a while at least. He couldn’t argue with her terms. No cheating, full disclosure. Always the joker, he stood to attention and put his hand on his heart, declaring, “I promise that when Sarah Abadhi, Esquire, does not sufficiently entertain me in every way, I will hereby say that that I want out.”

Not to be outdone, Sarah got up and stood face-to-face with Rick. She placed her hand on her heart and offered her play on his words, “I promise that when Richard Smith, M.D., does not sufficiently entertain me in every way, I will hereby say, ‘See ya later, busta.’”

After this perverse send-up on nuptial vows, Rick embraced her and whispered that, at that moment, he wanted very much to be in. Luckily, he still had an ample supply of condoms.

CHAPTER SEVENTEEN

The long winter finally yielded to spring, and Sarah and Rick continued to enjoy one another’s company. Given her low expectations, Rick was a ten on the “male-o-meter,” a rating system Sarah’s college friends used to rate the men they dated. She and Rick had a good time just about every time. They could talk about work, politics, running and swimming. After their discussion about Sarah’s infertility, they gave topics relating to their personal histories a wide berth. The only thing Sarah knew about Rick’s life story was that he grew up with his single mother in Michigan, and had been in a terrible car accident when he was five, the latter accounting for the many faint scars on his body. They rarely disagreed, and when they did, one was always ready to capitulate to the other. The issues that divided them were never more serious than what DVD to rent or which restaurant to order from, but nonetheless, each was conscious of the other’s desires and aimed to please.

Although they never made a conscious decision to hide their relationship, neither did they go out of their way to advertise it. In fact, only two people knew they were a couple: Jeff, Rick’s roommate, a.k.a. the “hairy ape” orthopedic head resident, and Devorah, Sarah’s best friend who lived in Chicago. If they passed someone they knew while coming off a run by the river, they chatted pleasantly and kept it light, with first-name introductions only. People at Sarah’s office saw more of her elusive dimples and figured she’d likely met someone. Rick’s reputation as a player was put in jeopardy when he failed to put the moves on any of the attractive female nurses for months, leaving co-workers scratching their heads.

The major exception, of course, was Jeff, who knew precisely what was preventing Rick from maintaining his position as alpha male among fellows and residents. Jeff liked Sarah from the get-go, and the feeling was mutual. They occasionally made a running threesome, with Jeff pushing himself to keep up and Rick and Sarah adjusting their pace to accommodate him. Once every few weeks, Sarah would meet Rick and Jeff for a drink or some supper on a Friday evening before she and Rick headed off to her apartment for the night.

There was no doubt about it: Rick and Sarah were compatible. Just as important, they each refused to give oxygen to the idea that their relationship was anything more than a great time. They were vigilant about not making plans. A week or two into the future was the farthest outpost of their shared horizon.

* * *

At the end of their fifth month together, Sarah, who had always been as regular as a clock, was late with her period; first a day or two, and then a week. She was under a lot of pressure at work with an important case: a professional pianist had lost his forearm due to a medical error. Unless they could work out a settlement, the case was going to trial in a few weeks. Though pressure was nothing new, Sarah thought maybe it was wreaking havoc with her menstrual cycle.

When she was ten days late, she began to feel light-headed. Her mind raced to every possibility. Was she coming down with some strange infectious disease? Was she developing a brain tumor? Perhaps it was premature menopause. She’d read about that happening to some women. It would be just her luck to have yet another insult to her damaged reproductive system.

She decided to call for an appointment with her internist. If she had some terrible disease, time might be of the essence. Her period was now two weeks late, but it also felt like it could come any time. She felt bloated. Her breasts ached right up through her armpits. She even had menstrual cramps. What worried her was that little things exhausted her — like going up a flight of stairs. Just the day before, she’d had to turn around early on her run. Maybe it was mononucleosis. How ridiculous would it be to get the adolescent scourge at age thirty-two?

The doctor’s office had a cancellation for that morning, and Sarah grabbed it. The doctor, Grace Tanaka, had grown up in a suburb northwest of Chicago — next door to Devorah. She had joined a bustling practice on the East Side after completing her residency at NYU. Sarah had visited her only a couple of times before. Each time they swapped tales of Devorah’s parents’ gourmet cooking skills and exotic vacations.

That morning Sarah was feeling especially woozy. When she arrived at the doctor’s office, she thought about taking the stairs, but then thought better of it. She opted for the elevator, signed in at reception, peed into a cup as requested and found a seat in the waiting room. After filling out the required paperwork, she opened her laptop to make the most of the inevitable wait.

After about half an hour, her name was called and she was shown into a small examining room. Dr. Grace Tanaka followed quickly on her heels.

“Hello, hello,” the meticulously groomed doctor said as she extended her hand to Sarah. “It’s good to see you. Have you heard from Devorah lately?”

“Oh, yes. We talk at least a couple of times a week. She’s doing well, busy with work, like the rest of us.”

“I don’t doubt it. She was always a worker, even as a little kid.”

“She didn’t graduate summa cum laude for nothing. She’s whip smart and, as you say, a worker,” Sarah said, remembering their college days.

The doctor scanned the form Sarah had filled out. “So, I see that general malaise has brought you in today. When did it start?”

“Maybe a week ago. And it’s funny because I have no fever, no rash and no sore throat. I just have no energy,” Sarah explained. “I can hardly go up a flight of stairs without being wiped out. And I generally swim or run before work, so something is off.”

“Do you notice any other differences?”

“Only that my period is late — but I think it’s coming any day. I’ve got all the symptoms: cramping, bloating, sore breasts.”

“How late, Sarah?”

“A couple of weeks. I don’t know if you remember, but I had PID several years ago. Afterwards, two doctors determined my tubes were completely blocked. So pregnancy is out.”

“I see on your form that you’re sexually active.”

“Yes.”

“And are you using birth control?” the doctor queried.

“The one good thing about being sterile, Dr. Tanaka, is the money you save on birth control. To answer your question, after having the tests done for STDs, my current partner and I have not been using birth control.”

“Okay, so I’ll have to investigate. You get into a gown; take everything off. I’ll be back in a few minutes and I’ll see what’s up.”

A few minutes later the doctor knocked on the door as Sarah was arranging her paper gown as modestly as she could.

“Come in,” Sarah said.

The doctor began with the usual: eyes, nose, ears, throat, thyroid, reflexes. She listened to Sarah’s heart and lungs and took her blood pressure. Then she told Sarah to lie down on the table. She examined her breasts and her belly before having Sarah put her feet in the stirrups. After examining her vaginally and rectally she told her she could sit up.

“Well, Sarah. Everything is unremarkable with the exception of your uterus, which is a bit enlarged. As you expect your period any day, that could explain the enlargement. I won’t be able to get to the bottom of this without some lab work. I’m going to order a CBC and some tests to measure your hormone levels. Low thyroid function could make you feel punky. It could also throw off your menstrual cycle. But I really don’t want to speculate until I get the results of the blood work.”

“Sure. Needles don’t bother me. Can you do the lab work right here in the office?” Sarah asked, hoping to expedite the process.

“Actually, there’s a lab on the second floor of this building that can do the blood draws. You can use that lab or any other. I’ll give you an order and you can take it wherever you like.”

“When will you get the results?”

“I could get them within the day if you get to a lab this morning. I’ll give you a call — certainly by tomorrow — with the results.”

“That’s great. I just want to shake this weird feeling. The sooner you know the cause, the happier I’ll be,” Sarah said.

“It’s a deal. Remember, Sarah, you’ve got Dr. Tanaka on the case now. Together we’ll solve this puzzle.” The smiling doctor shook Sarah’s hand again and said, “Please, say hello to Devorah the next time you talk.”

“I certainly will — and thanks. I appreciate you seeing me on such short notice.”

After the doctor left, Sarah dressed quickly. As she did the last button on her skirt she was relieved to know that whatever was bugging her would soon be identified. If she was lucky, there would be a treatment and she’d be back to herself in no time.

* * *

Sarah was in her office eating Chinese takeout when the call from Grace Tanaka came in around seven. Rick had texted earlier to let her know he was swamped. And from the looks of her desk, she’d be lucky to get out of there by ten.

“This is Dr. Tanaka calling for Sarah Abadhi.”

“Oh, hello, Dr. Tanaka. This is Sarah. Thanks so much for calling tonight.”

“I hope it’s not too late.”

“Oh, no, not at all. I’m still in the office. Did the blood work give you any leads?”

“Lots of good news. Your hematocrit and hemoglobin levels are good. Your white count shows there’s no sign of infection — so we can rule out mono and leukemia. Your thyroid function is normal, so we’re not dealing with hypothyroidism. But there was one surprise in the blood panel. Sarah, your blood work shows HCG — the hormone that’s produced during pregnancy.”

There was silence for a good fifteen seconds. “Sarah, are you still there?”

“Yes, yes, I’m still here…but I don’t understand. How can that be? My fallopian tubes are blocked. Perhaps the lab made a mistake.”

“Well, as I said, I’m surprised as well. All things considered, I would say the probability of a lab error is slight. And given your history, we really need to rule out an ectopic pregnancy — a pregnancy that implanted outside of the uterus, either in or near the fallopian tubes. I suggest you follow up on that right away. An ectopic pregnancy can be quite serious if not treated early.”

“I don’t understand how this could have happened.”

“Sarah,” the doctor responded calmly, “we don’t know exactly what has happened except that it’s likely conception has taken place. Do you have a gynecologist I can send these results to?”

“Yes…yes, let me see. It’s Dr. Scholl. Dr. Jared Scholl. I’ll get his number for you if you give me a minute.” Sarah found the number and read off the digits.

“Okay, Sarah. I’m going to call his office and make a referral for you. I suggest you see him as soon as you can. He’ll likely do an ultrasound to see where the embryo is growing — and then you’ll have the information you need for the next step. I want to reiterate the good news, Sarah: You’re healthy and your malaise is consistent with normal symptoms of the first trimester of pregnancy. You are not sick.”

Embryo. First trimester pregnancy. Not sick. Sarah was having trouble processing the doctor’s words. “Thank you. Thank you very much for that, Dr. Tanaka. I was thinking you might find a brain tumor or some other terrible illness. But pregnancy…I don’t know what to say. I’m astonished. But I do appreciate you reminding me that I am, in fact, healthy, and that is definitely a relief.” She realized she was rambling and that the doctor likely had other calls to make. “I’m going to call Dr. Scholl’s office tomorrow — and I’ll make sure he shares his findings with you. Thank you again. You’ve been a great help.”