A walk to Remember..

Part one

There is no love like the first. It comes with the innocence and simplicity of youth. Something about it defies duplication. Before it, your heart is blank. Unwritten.

When 20 year old *Ann met *Dennis at a Business College, she did not know that it was he who would walk her through life’s hardest trail. She was a shy, focused, high achieving girl and he was the good natured class comic who could draw laughter from a rabid dog.

As fate would have it, after completion of their Accounts course, they applied to join the same University. With his wit and good charm, he managed to draw her in and they soon became fast friends. It is this friendship, that saw them take long walks across town when the sun yawned and was ready for bed. It became their daily ritual. Take a ride into town then walk around and dream. Their conversations had no beginning and no end. It was like they were always in a continuum. They would hold hands and draw the different shapes of their future as they spoke. The concrete was laid; the foundation set.

It wasn’t difficult therefore to graduate into a dating relationship. It seemed the obvious thing to do. And the bond grew. Eventually they completed University, got into employment and tied the knot. Life, for them, moved in a seamless straight line.

As they stared into each others eyes and recited their marriage vows, they didn’t know that the straight path they had enjoyed in the years past, would become raw and uneven. First, they hadn’t conclusively decided when they would start to grow their family. He was ambivalent about children. Neither their presence or absence would move him. She, wasn’t ready to include them in the equation just yet. So there was no urgency to discuss the stalemate. And so they enjoyed the first four years of their marriage assuming that conception was like a buffet. You pick when to eat, when to stop and when to have seconds. Right? Wrong.

Two things happened that brought them to a consensus. Their friends started popping babies. Dennis derived so much pleasure playing with his friends tots that his ambivalence shifted. He started to desire his own scions to make faces at and carry on his back. And Ann was finally ready to expand their home. And so they excitedly started the process of trying.

“When you are trying for a baby, it always starts out as fun.” Ann quipped. “You enjoy the moments as you imagine the miracle of cells coming together to form your little human. You are full of optimism and it’s often a task to keep up with your imagination. You imagine a girl and what she would like, or a boy and how he would act like and it’s bliss.”

But with time, the bliss turned into worry, then doubt, then apprehension and finally full blown anxiety. The visits to the gynecologist began. They were both evaluated and found to be in tip top shape. Ann was therefore started on a trial six month cycle of hormonal treatment. Like with any treatment, the first cycle was coupled with hope. When it failed, the hope began to dwindle; but with five more cycles to go, they kept hope alive. She finished the six cycles with nothing to show for it.

They were then referred to a fertility specialist where a HSG ( remember that test from my previous post — https://medium.com/@medroomeyes/even-miracles-take-a-little-time-9a0fd8a086a9) was ordered. For some reason when it was time to push up the dye, the doctor was hitting a brick wall. There was some form of unexpected resistance. He returned Ann to sender with a report saying, ‘test not done.’ Dr. Fertility was perturbed so he opted to take her in for a diagnostic hysteroscopy. This is a minimal access procedure used to evaluate the cervix, uterus and tubal openings. So she was prepared for surgery and they went in. The first thing he noticed when he looked at her uterus and tubes was a lot of scarring. Being an unusual finding, he took a biopsy. Nothing else seemed to be off. The resistance that was earlier felt during the HSG was due to the orientation of her cervix. It was slightly bent. Nothing to write home about.

A few days later she went back to Dr Fertility for her results.

“It seemed he hadn’t looked at them before we walked in because he pulled them out so casually expecting nothing. Then he read the report and I saw an obvious look of shock on his face.” Ann said

“You have endometrial tuberculosis.” He said almost to himself.

“What!” They said in unison.

Surely of all the places that TB would decide to reside, it chose her uterus! I mean there must have been more accessible body organs to infect. Her lungs maybe. But her uterus? It felt like a slap in the face. To add pepper to an already heavily spiced meal, he said there was no way to tell when or how she got it. She just had it. So, she was referred to yet another specialist — a physician this time- to evaluate her and start her on anti TB treatment. She held her tears long enough to walk out of the consultation room then broke down into pieces. How does a journey of conception end up in a diagnosis of TB? Dennis held her; unable to fathom the shock himself.

The treatment was commenced and she was on a cocktail of drugs for six months.

“God was gracious to me. I was told to expect several side effects but the one that tickled me the most was when the doc said my urine, tears or saliva would turn orange! Imagine crying orange tears! Luckily enough I had none of the adverse effects they told me to expect; well except grey lips.”

The six months went by uneventfully as the drugs became part of her life. Her load was lessened by her cheerful husband. Nothing could put that man down. Always had a way to make her laugh and lighten her load.

She completed her treatment and was back to Dr fertility for the next step. He gave them three options considering their history and prevailing circumstances: IVF, surrogacy or adoption. After much deliberation, they settled for IVF. In the beginning, prior to treatment, the doctor told her what her odds were. It was a percentage. The kind you wouldn’t want on your math test. Regardless, they went ahead because you can’t fail unless you try. Throughout the entire process, she responded well to treatment. Even better than the odds she was given. During ovulation induction, she produced more eggs than expected and after fertilisation she had two Grade A embryo’s. (https://medium.com/@medroomeyes/even-miracles-take-a-little-time-9a0fd8a086a9). After implantation the two week wait begun. They were full of optimism because of how everything had turned out so well.

Two weeks later on the day she was to receive her pregnancy test, her uncle — who was more of a father to her — breathed his last after a long illness. She was seated on a cold hospital bench at 5:40am when she received the news of his passing. A few hours later, Dr Fertility called her and dug her deeper into the hole of despair. The IVF was unsuccessful; and he honestly could not understand why. Choosing to honour her uncle, she took this news and buried it with him. But after the funeral was done, the dissapointment and agony was resurrected. They now had to visit the doctor to have the unavoidable conversation of what happened and see the way forward.

The doctor advised on a second hysteroscopy and biopsy: to try to answer the question of why. And depending on the results, see whether trying again was an option or not.

“ Doc,” she said to me, “ I think I am having a mid life crisis of sorts. I am going to be fourty next year and it feels like my window is closing. But I keep remembering Hannah, Sarah and Elizabeth in the bible and say to myself surely my story cannot end like this. But I think of going through this process again and getting another negative and I shudder.

Some of my hardest days are when a friend or a family member tell me they are expecting. I am genuinely happy for them. Yet I resonate with the words of Alisa Turner — (https://www.youtube.com/watch?v=N1OZNMBi2u0) when she sang that ‘How long will I hear the stories of how You are able, How long will I celebrate a miracle that’s not my own, How long will I sing again that you are always good.’ The song ends on a high note but I wonder when my miracle will come. There are days Dennis and I sit and wonder what would happen if one of us died. The other would remain all alone: or when we are old and frail, who would take care of us. Those are low days. But they are few and far between.

My sisters and in laws are the reason I know love is real. My mum in law would almost beat up anyone who dared to ask me why we don’t have children. She has never asked me once and she is not aware of the intricate details of our journey. Because of this stand she has taken, the rest of Dennis’ family have followed suit. I have never faced any form of discrimination or questions from them. They have loved me in a way that I dont think they truly understand — despite not knowing the situation.

This trial has brought us closer together than driven us apart. Dennis protects me fiercely. He attended every single appointment and has never once made this look like my journey: he says it’s our journey. I look back at the foundation that was laid when we were dating, and it has held strong. Sometimes I feel like I have let him down. That I can’t give him a child. I feel for him and he feels for me. I remember the walks in the sunset in our 20’s and I thank God that he is still by my side. Sometimes I read about other people’s experiences and their struggles in their relationships, I am glad that on top of this, I don’t have to deal with an unsupportive spouse.

Love is not, ‘if’ or ‘because’, it is ‘anyway’, ‘even though’ and ‘in spite of’.

• Anne and Dennis are yet to go for the second evaluation. That is why the story is going to be a two part series; even as we root for them and hope for the best. Stay tuned.

Tuberculosis of the female genital tract can involve the fallopian tubes, the endometrial cavity, and the ovaries; cervical and vaginal disease are rare.

Genital tract TB has been associated with 0.2 to 21 % of infertility cases.

The fallopian tubes are affected in 90 to 100 % of cases, usually with bilateral involvement.

Infection may progress from the fallopian tubes to the endometrium in 50 to 70 % of cases. Presence of endometrial tuberculosis almost always means that the tubes are infected.

Female genital tuberculosis presents clinically as infertility , pelvic or abdominal pain or mass and menstrual disorders.

Infertility develops as a result of tubal obstruction or adhesions of the uterine cavity.

The diagnosis of female genital tuberculosis should be suspected in patients with infertility, pelvic or abdominal pain, and/or menstrual disorders as well as history of prior TB infection or disease, known or possible TB exposure, and/or past or present residence in or travel to an area where TB is endemic.

Hysterosalpingogram (HSG) may demonstrate fallopian tube obstruction or constriction and/or uterine cavity adhesion or deformity

Diagnosis may be made by biopsy for histology and culture or via culture of menstrual fluid.

Treatment: Anti tuberculous drugs