Between Science and Story: Reflections of a Physician

When I was contemplating retirement, a colleague asked me what I planned to do. "I'm going to write a book," I said casually. "Oh really?" she said. She asked what kind of story I'd write, and immediately I knew it would be set in an IVF Clinic. I had worked in such a clinic for a year before heading off to private practice. During that year, I witnessed a vast spectrum of human emotions--anticipation, hope, anger, joy, grief, and love. I watched couples grow closer through the process, and some whose marriage did not survive. These amazing people were driven by a fierce desire to become parents. Their courage was humbling. I never had difficulty getting pregnant, and I remember telling my friend that I didn't know if I possessed the same inner strength I observed in these people, Their stories stayed with me.

Every day in an IVF clinic begins with hope. It's there in the early morning quiet before the first patient arrives, in the hum of the ultrasound machine warming up, and in the nervous smiles exchanged between patients as they sit side by side awaiting blood draws or ultrasounds. It's there during the conversations about medication doses, how many embryos to transfer, and when to come back for a pregnancy test. And it's there when a cycle doesn't end with a positive pregnancy test--maybe next time...

Reproductive medicine is a unique intersection of science and emotion. On one hand, it's intensely technical. Everything is measured: hormone levels, follicle size, sperm counts, embryo grades. The potential for human life is frozen in tanks of liquid nitrogen and ovulation is timed down to the hour. Yet, for all the control we try to exert, the process remains unpredictable and mysterious. Biology doesn't blend easily to our will. In the space between science and uncertainty, patients place an extraordinary amount of trust in their physicians. That trust is sacred--so my writer brain began to plot--what happens when that trust is broken in the most basic way?

All physicians struggle with boundaries and how to protect ourselves from the emotional weight of it all. One strategy is to focus on details like the numbers or steps in the protocol. Sometimes, it's easier to think in terms of outcomes and data than to dwell on the heartbreak that so often accompanies infertility. But sometimes, it's hard to separate science from human stories. The patient who brings cookies after her third failed cycle. The woman with premature menopause whose sister agrees to donate her eggs even though she is childless. Or the couple who sends a note after a miscarriage, thanking the staff for their kindness. And sometimes, there is anger. Anger at their bodies. Anger at the doctors. Anger at the unfairness of life. And loss and grief. So much loss and grief. Some days feel very heavy.

All this came back to me years later when I began to write. Writing became the place where I could remember the contradictions, the uncertainties, the emotions. Working in an IFV clinic and later with infertility patients in my private practice taught me that creation takes many forms, like the moment when a long-awaited pregnancy test finally turns positive or helping a patient find peace after a devastating loss. My medical background makes me a better writer and grounds my words in reality, in complex and life-changing events. Medicine gave me structure and purpose, a very specific way to assist patients in creating a new life. And writing helped me forge a deeper understanding of that life within the context of creating not just an embryo but also creating a distinctive bond between the partners who share this experience and want this new life so deeply.