Sometimes, the little things get you

Here's a short poem that I'd like to share to start the blog. It's not always the monumental things events in our lives that make us break down. Sometimes it's the little things that happen during times of massive stress that solidify out state and make us melt in the spot. They catch us off guard and already worn thin.

Shoelace

it’s not the large things that 
send a man to the 
madhouse. death he’s ready for, or 
murder, incest, robbery, fire, flood… 
no, it’s the continuing series of small tragedies 
that send a man to the 
madhouse… 
not the death of his love 
but a shoelace that snaps 
with no time left … 
The dread of life 
is that swarm of trivialities 
that can kill quicker than cancer 
and which are always there - 
license plates or taxes 
or expired driver’s license....

As my wife and I waited for the test results of the various exams I took in the weeks before, we started to plan the "next steps" of assisted conception through what is known as ICSI-IVF. ICSI-IVF stands for intracytoplasmic sperm injection-in vitro fertilization. What ICSI-IVF essentially amounts to is the extraction of sperm from a male which gets "injected" into harvested eggs from a female. Its a very expensive and complicated procedure which is an amazing process, but one that is also incredibly prone to failure (success rates can be as high as ~50%, but typically are a lot lower and multiple attempts are usually necessary).

So what is ICSI-IVF exactly? To me, it sounded a lot like the doctors were simply impregnating my wife's eggs with the sperm they would extract from me and then implanting them back into her. The physical cost: my wife would have to take large, muscular injections near the back of the pelvis for the better part of 3-4 weeks, as well as hormones and other light injections. My wife, God bless her, was scared as all hell over the idea of taking so many shots and having to go through all the bodily changes that comes with such hormones. But she was a trooper, and I was so proud of how she kept herself composed and positive as we embarked on an endearing and torturous journey.  Even now, as I hear her watching TV in the bedroom as I type, I can see my sweet, playful girl prepping herself like a soldier that is readying to go to battle - telling herself to be strong, be brave. And she was so, throughout this entire debacle. I was and am still so very proud of her.

For me? Testicular sperm exploration and, hopefully, extraction. One such process is Fine Needle Aspiration (FNA) Mapping.  In fine needle aspiration (FNA) mapping, there are roughly 18 aspirations with a needle, surgically pierced into EACH testicle (for a total of 36 "punctures") with an extraction of some intra-testicular medium. Each sample will be examined by two independent labs to determine if there is any sperm being produced in the testes. Then, assuming sperm is found, there are TESE and mTESE procedures. TESE is also known as Testicular Sperm Extraction, where the scrotum is sliced open, and one or both testicles are further sliced "opened" to reveal the inner "tubings" where samples are taken which may or may not yield sperm. mTESE is a variant of TESE were a microscope to aid in the extraction of testicular tissue is done so that less testicular tissue can be taken with a better chance of finding sperm. In other words, both will hurt like shit, and the "balls" are gonna be swollen.

Let's talk about the money. ICSI-IVF would cost about $30k, for 2 attempts. FNA-mapping costs about $6-7k (since we chose to go with one of the best FNA-mapping specialists in the world, who happens to practice in SF). TESE/mTESE would be another $5-10k depending on how little sperm there was (i.e. how hard it would be for them to find the swimmers).  Before subjecting my wife to anything, I decided to get FNA-mapping done on myself to determine if there was even any sperm worth betting ICSI-IVF on. My appointment in San Francisco was on May 31, 2012. That was one day after my wife and my 3-year anniversary.

On the day of my surgery, my friend C picked me up. I was happy that someone could accompany me and that my wife could be spared from having to wait in the waiting room thinking about my surgical discomfort. She would be working until later that day, and my appointment was at 3pm. I arrived at 2:30p, by 2:45p I was a little loopy from the valium they gave me. She really wanted to come, but I thought it was better if she didn't and I would see her at home immediately afterwards. I remember as I was getting prepped for surgery, the thought of most my friends not knowing anything about my surgery nor about my condition made me feel isolated. The nurse left the room for a moment, and I remember how alone I felt - and for a while, I wished I could hear my friends tell me everything was going to be okay, and that they would be there when I got home. Even till this day, most of my friends, even the ones that know of my azoospermic condition and surgery can barely remember the feelings I had, or could care less. But they are still very real to me. Even nearly a year later, I can still feel emotions put a strangle hold on my thoughts when I recollect.

As I lay back on the surgery table, bare naked, the nurse completely shaved my scrotum (rather quickly which was horrifying even with the valium), it became very real that my testicles were about to have a major "attack" happen to them. And then, she applied what felt like really hot water on my scrotum. It was a topical analgesic, and it made my balls feel like they were on fire. Then the real fun began: 6 inch needles filled with local anesthesia. They were injected about 2-3 inches into my groin area and it was very uncomfortable but I didn't budge, I was too scared of what might happen if I did. I barely breathed.  All said, the doctor gave me 4 shots on my left groin, 3 on my right. He was about to delay the surgery as I was not getting fully numb, but I asked him to just proceed. I hadn't come out here and go through all this just to go back home with partially numb testicles. And so with a little discomfort he proceeded. 36 aspirations where he stuck a needle about 1/4-1/2 inch into each testicle, 18 times. When everything was done, I was still a little loopy from the valium, but very happy that the procedure was over.

My friend C was waiting for me in the waiting room and it was great to see him, and thankfully he was able to drive me home. Amongst all the friends that tried to say the right thing, that were absent from it all, that were too busy to come by, and to those that just didn't make an effort to call after not hearing from me for a year.....it was C that came thru the most. He just came by to, well, come by. To watch TV, to eat some food. Not because he felt sorry for me, or because he thought I needed it - but because he just wanted to hang out. To me, that was the sign of a great friend. Even people that don't like you will be there when you are really down (say when a parent passes away), but the ones that come by just because they like being around you and just like seeing you......well, those are the ones worth keeping the most.

One thing I learned from all this was that there are only a handful of times in your life that allow you to define who you are and what you're willing to do.  I think, amongst many things, friendships intersect at such junctures. It's the people that shine in those moments, without necessarily intending to rise to an  occasion,...... those are the ones that define friendships for other people. Other people, like me, that were on the receiving end of an unintended but generous gift. Thanks C, and, of course - thanks to my wife.