Issue 11: Mind blown by the US medical system
Saturday August 25 2018
My only previous experience of a US hospital was watching Dr Doug Ross shoot hoops outside County General. On ER. Walking into the fertility clinic in Miami, with its 1980s spiral staircase and faux flowers in an extravagant centrepiece, feels more like Dynasty. Is this typical of American hospitals? I hope I never get to find out, because after two blood tests, the sperm deposit and a questionnaire in a room with no chairs, we leave with a HUGE dent in our bank account. Ooph. Repeat to self: “America is the gold standard in surrogacy. America is the gold standard in surrogacy.” And breathe.
While we wait to meet our agency-recommended doctor, I peruse the room and feel the familiar stab of envy at the couples with the biggest bellies. The women, I mean. The men with the biggest bellies can stay — they are not an emotional threat to me. I leave my man-with-a-small-to-medium-belly jiggling his leg in nervous anticipation of the appointment and go to buy some breakfast (we’ve been too edgy to eat until now). The exclusively doughnut-based offerings in the hospital café lead me to better understand the width of some of the people in the waiting room, and I go back to my seat with only a couple of coffees to fuel our anxiety further.
But why the nerves? I’m surprised at myself. I feel a bit like we need to pass a test, but I can’t put my finger on why. Maybe because this is such a “system”. We have little understanding of it; we’re being officially inaugurated into it, in another country and I feel intimidated by medical professionals at the best of times. After a longer-than-NHS-length waiting time, we go in to meet Dr Fernando. He has an impressive moustache, very kind eyes and is kind of kooky. Kookily, his initial focus is on me: the only non-essential part of the process. “Tell me about your medical history, was the cancer genetic, how did you find the tumour, how old were you, tell me about your recurrence, what medication are you on now?” etc etc. These kind of questions make me want to get back into bed, but just as I’m reaching peak unease, he says: “So if we get nice embryos, maybe we can try again to implant in you in a couple of years.” Heart-soaring loveliness, that. Even though, after the Russian debacle, I’ve decided I could never put myself through that physical and emotional pain again, the fact that this new doctor wants to give me hope and put me back in the middle of the picture means an awful lot.
The real news? Dr Fernando’s success rates with donor egg IVF/surrogacy is high, about 70 per cent. Seventy per cent! Just to put that into context, the doctors I was working with in the UK and Russia had a success rate of about 40 per cent. It’s questionable exactly how clinics derive these stats, and nearly impossible to regulate, but we know what affects the outcome.
First, the quality of the donor eggs, with common belief that the best will be from donors who have had one baby before. (Donor 436 hasn’t, but we’ll pretend I never discovered that fact.)
The experience of the embryologists and the quality of the lab are crucial and can really influence the success rate. It’s not as simple as facilitating a meeting in a petri dish, then bunging them in the freezer — obvs — but how am I supposed to know if Dr. Fernando’s lab is better than Dr Sokolov in St Petersburg, for instance? I’m just Joe Bloggs (or Sophie Journals) from southeast London. For starters, Dr Sokolov refused to give us any stats (“same as everywhere”) and we accessed her clinic through an unmarked back door in a shady pharmacy. But Dr Fernando is proud and protective of his, and he has lovely faux flowers and a spiral staircase. I’ll take the Dynasty clinic with the kind, encouraging doctor, thanks.
Next, Mr B sits in a chair, pale and sweaty while they take 12 phials of his blood, which seems somewhat excessive. I have packed boiled sweets for any signs of dizziness — see, I’m practically a mother already. Then they take two of mine — I cynically suspect to bump up our bill, but am told it’s in case I have any STDs I might pass on to my husband. He has already made his sperm donation, though, so this just feels downright nosy.
Then we’re taken into a photocopying room (Dr Fernando and his high success rates bring all the girls to the yard, and damn right he’s better than most, so all the exam rooms are already taken), where Mr B is grilled by the nurse. Grilled-d-d. And THIS is where he chooses to be “funny”.
Nurse: “Just to let you know, we have to ask some important questions to make sure you are eligible to move forward with the treatment here in the US.”
Mr B: “Of course, anything you need.”
Nurse: “Have you travelled to a Zika country in the last six months?”
Mr B: “No.”
So far, so good.
Nurse: “Have you had sexual intercourse with a man in the last six months?”
Mr B: “Hmmmm, let me think. Last six months? I don’t think so, no.”
This is humour in his world. I shoot him a withering look across the photocopier.
Nurse, looking unamused: “Have you ever injected any Class A drugs, specifically in the last six months?”
Mr B: “Injected? Um, not injected, no.”
If the damn photocopier wasn’t in the way, Mr B’s sperm would be compromised by a boot to the balls right about now. He sees it in my eyes and manages to get through the rest of the questions with minimal wit and — yay! — we pass.
Now we just need to pay. *Screech of tyres*. It is said that medical debt is a leading cause of bankruptcy in the US. Our bill for this two-hour appointment is $2,500. No wonder those faux flowers are so bloody impressive. I imagine the embryo freezers are like my friend’s supremely stylish Smeg. But platinum and with diamond-encrusted embryologists manning them.
As I mentally justify this expense as six months’ worth of Starbucks that I won’t order, we wait for our Uber to the hotel (hotel bar, who are we kidding) full of excitement and a little bit in love with Dr Fernando and his wonderful moustache — I mean manner. This man will bring us our baby! There’s a flipping swan on the lawn. Wonder how much that cost . . .