Sunday, November 30, 2014

Infertility in the Hebrew Bible

Parshat Vayetze has endless topics that one could talk about, including Jacob’s famous dream, Rachel destroying her father’s idols, and the sympathetic magic that Jacob utilizes to increase his flock of sheep. However, what touches me most deeply in this parsha is Rachel’s infertility and what it can tell us about helping couples struggling with that problem today. 

In Vayetze, we read that Jacob served his uncle, Lavan, for 7 years to marry Rachel, but Lavan tricked him into marrying her older, and less desirable, sister Leah. Jacob then worked another 7 years to secure Rachel. Jacob strongly preferred Rachel, but Leah conceived and had 4 sons before Rachel had any. At this point, the parsha says “And when Rachel saw that she bore Jacob no children, Rachel envied her sister; and she said unto Jacob: ‘Give me children or else I die.” This is a very dramatic thing to say, but it is a sentiment that resonates for many of the 1 in 8 couples in America struggling with infertility. The Torah says that “Jacob’s anger was kindled against Rachel; and he said: ‘Am I in God’s stead, who hath withheld from thee the fruit of the womb?” (Gen. XXX:2).

Rachel seems to be issuing an ultimatum to Jacob: I don’t want to live if we can’t have children together. According to Ramban, Jacob was angry because Rachel went to him and said, “Your father, Isaac, prayed for a child and your mother conceived twins. Therefore, you must not be praying hard enough. You don’t care enough about me.”  Ramban further explains that Jacob was angry because the implication was that he should be doing the petitioning, and not Rachel herself, or the two of them together like Rebecca and Isaac prayed side-by-side for God to give them a child. According to Ramban, Jacob replies by saying “this is in God’s hands, not mine,” and hints that maybe Rachel needs to take action besides just praying. Rachel’s immediate response to her husband’s anger is is to offer up her maid, Bilha, in order for him to be built up, just like the childless Sarai offered her handmaid Hagar to Avram. 

There is another commentary on Jacob’s angry response which resonates much more with me, but we’ll visit that later. 

It’s important to note that all of the patriarchs married women who were barren. The prophets Jeremiah (30:17) and Isaiah (59:20) constantly compare the land of Israel during the Jews’ exile to a barren woman, because just as Zion is in pain during the exile, so is a barren couple in pain throughout their infertility journey. I think that this pain can be especially sharp in the Jewish community, which places so much emphasis on the importance of Jewish continuity, and where so many synagogue and social activities revolve around children.  A Jewish couple experiencing infertility has a special kind of pain: after all, the first commandment in the Torah is to be fruitful and multiply, and the Jews are a nation whose origin is the fulfillment of God’s promise to an infertile couple -- Abraham and Sarah -- that they would have a child. Rather than just viewing infertility as a medical condition, some Jewish couples view it as a judgment by God.

Why does the Torah place so much emphasis on infertility and what is it trying to teach us? One possible reason is to remind us that children are a gift from God, and not to be taken for granted. Another is to offer two possible spiritual approaches to dealing with infertility -- or for that matter -- any existential challenge. One is to use prayer. This was the approach of the barren Hannah, whose story is read on Rosh Hashana, and whose prayer becomes the model of our daily amidah. Prayer is such a natural response to infertility that Chazal assert in Shir haShirim Rabbah (2:14) and Bereishis Rabbah (45:5) that this is why God rendered our matriarchs infertile: because God craves the prayers of the righteous. I don’t pretend to know the mind of God, but I disagree with Chazal on this point. Firstly, because it seems capricious and cruel, and secondly, because our foremothers had enough other issues that would have caused them to petition God in prayer.

The other way that the matriarchs and patriarchs responded to the affliction of infertility is to undertake some form of extreme sacrifice. As I mentioned, Sarah, Leah, and Rachel all encourage their husbands to sleep with their handmaids in order to secondarily have children and build up their lineage. Hannah makes what most mothers would view as the ultimate sacrifice: giving up her hard-won son, Shmuel, to be reared away from her in service to God at the Temple. A similar story of sacrifice exists in this week’s parsha, too: Rachel and Leah negotiate that Jacob will sleep in Leah’s chambers in exchange for Leah surrendering the the mandrakes, a fruit that reportedly was an aphrodisiac, that her son Re’euven collected (the Torah tells us that Leah’s son Isaachar was conceived from that arrangement). The commentator Sforno says that Rachel only conceived Joseph after God saw that she made a strenuous effort to have children by giving her handmaid up to sleep with Jacob, by negotiating for the mandrakes, and by fervent prayer.

Please don’t think that I am suggesting that couples struggling with infertility should consider open marriage as a potential solution to their dilemma. God forbid. However, the modern version of this could be taking on extra mitzvaot when one is seeking God’s intervention in overcoming a challenge or seeking God’s resolution to a problem. Furthermore, any couple who has undergone the emotional, financial, and physical rigors of any assisted reproductive technology can attest that they are already making a significant sacrifice in order to try to have children.

I want to return to Rachel’s heartbreaking comment that she must have children or she will die, and Jacob’s anger at that response. The 15th century commentator the Akedat Yitzchak offers a different explanation than Ramban’s, and one that I find much more compelling. He writes that Jacob bristled at his wife’s comment because although having children is an important part of life, it is not the only part of life, and to suggest otherwise is not a Jewish value. What is a Jewish value is to live a life that is meaningful in other ways, even if one cannot have children. Frankly, I would argue that this is a Jewish value even if a couple is blessed with children.

Ultimately, all of the matriarchs had children, but as we know, sadly, this is not the case for everyone experiencing the pain of infertility. I believe that what the Torah is teaching us is that it is important to be generative, whether or not one has physical children. I am thinking of the last Lubavitcher Rebbe who had no biological offspring, but who often said, “I have thousands of children,” referring to Am Yisroel. I am also reminded that parshat Bereishit interrupts the telling of Noah’s generational line to praise Noah‘s character. The verse states: “These are the generations of Noah. Noah was in his generation a man righteous and whole-hearted. Noah walked with God” (Genesis 6:9). After promising an introduction to the sons of Noah, the the pasuk goes on to praise him; his children are only mentioned in the next verse. From this, the midrash infers that this teaches us that the main progeny of the righteous is their good deeds.

I want to end with a hopeful verse from Isaiah (56:3) "Let not the eunuch say, 'Behold, I am a dry tree.' For so says the Lord to the eunuchs who will keep My Sabbaths and will choose what I desire and hold fast to My covenant: 'I will give them in My house and in My walls a place and a name, better than sons and daughters; an everlasting name I will give them, which will not be discontinued.'" 

Regardless of marital status or if one has children or not, we can all contribute to our Jewish communities, thereby growing the nation of Israel, which is the offspring of all of us. Shabbat shalom. 

Friday, July 5, 2013

Radio Silence aka Hearts Burst Into Fire

Written June 6, 2013

"It hurts! Wounds so sore! Now I'm torn, now I'm torn.
I've been far away: when I see your face my hearts burst into fire." 

-- "Hearts Burst Into Fire," Bullet For My Valentine

There has been radio silence on my blog for two reasons: 1. I have been sick as a dog with first-trimester pregnancy symptoms of nausea, fatigue, and light-headedness. Some days, I am incapacitated by it. 2. All I want to write about is this experience, which I have been too scared to talk about publicly. For that matter, I still am.

All women are nervous during their pregnancies. Who doesn't want a perfect, healthy baby? And what is more uncontrollable than this most precious of outcomes? But, for most of us who have had a pregnancy loss -- and all the more so when you have had many pregnancy losses -- the fantasy of a glowing, relaxed pregnancy just won't happen. Consequently, I have been a nervous wreck. Last night, however, I had a total nuclear mental meltdown. Someone I know posted something about a five-month stillbirth on Facebook, and I had an out-and-out panic attack.

One thing that's nice is that this has been a very closely monitored pregnancy. Not because monitoring would affect the outcomes, but because it makes me feel better. With each positive sonogram I can stay on this side of sane for a few more days, until the anxiety again takes over ("Wait! I don't feel queasy this second" or "Wait! My boobs only hurt a 6 out of 10 instead of a 10 out of 10!")

The above-quoted lyric from BFMV really captures my mental health right now: I am truly traumatized by my miscarriages, and oh, the wounds are still so very sore. The sonograms are like CPR for my soul, so I can check on the little one. And yes, when I see his or her face, my heart bursts into fire.

Thursday, May 9, 2013

Email To A Suffering Woman

I got an email from someone who just suffered a miscarriage after her one and only pregnancy after trying to conceive for five years. She asked for my advice on how to move through it, since she is in so much pain. I am posting my response to her here, in case it contains advice that helps someone else who is hurting.

"Dear H,

I am so sorry for your loss. I have been through this three times, and it is excruciatingly painful. Since you asked for advice about how I survived, here ya go. Take what you like and ignore the rest:

1. You WILL get through this. One day at a time, sometimes one hour at a time. You are grieving, and that is ok. Take it easy on yourself, and stay out of self-judgement. Try to take good care of yourself, the best you can: good nutrition, getting to bed at a reasonable hour, perhaps tea with a trusted buddy you can cry to. If you are spiritual and part of a faith community, connecting with that might help, though anger at a Higher Power is totally normal, too. And, dare I say it, exercise helps. Getting my ass to the gym post-miscarriage was one of the best things for me mentally and physically.

2. The biggest challenge for me was that my husband and I grieved the loss of our babies differently. It was very hard to be with him because seeing his face (the father of my kids!) really heightened my grief. He was the only other person on the planet suffering the way I was, and sometimes being with that was too much. Instead of pulling away, I had to consciously move closer to him. Not easy, but worth it. We had to figure out a way for each of us to grieve our own ways; me by wallowing in it for a while, him by losing himself in work. One isn't right or wrong, better or worse. Just different, and we had to allow space for each others grieving styles.

3. This is very, very hard to hear, and I don't say it lightly. Nor would I say this to you without having lived through this: as much as I understand your sentiment that this feels worse than just not conceiving, it is actually a very hopeful sign for your ability to conceive in the future. Several reproductive endocrinologists have told me, "It's a sign that something is working." Cold comfort for where you sit now, I know.

Please know I am sending healing thoughts your way and I am here if you need something. This hurts like hell, and yet you will rebound, I promise. Winston Churchill wisely said, 'If you're going through hell, keep going.' Take it easy.


Tuesday, April 9, 2013

Book Review: Conquering Infertility

Conquering Infertility: Dr. Alice Domar's Mind/Body Guide to Enhancing Fertility and Coping with InfertilityConquering Infertility: Dr. Alice Domar's Mind/Body Guide to Enhancing Fertility and Coping with Infertility by Alice D. Domar

My rating: 4 of 5 stars

"Conquering Infertility" is not a perfect book. It was written in 2002, and a lot of the medical landscape of assisted reproductive technology -- particularly in-vitro fertilization success rates -- has changed dramatically for the better. In spite of that and a few other issues, I still found the book a very worthwhile read.

The first part of the book instructs on some basic relaxation techniques to help calm the overactive stress system that gets engaged when you are undergoing infertility (IF) treatment. Domar details how to engage in progressive relaxation, visualization, and other techniques to kick in the relaxation response. She does this not because she claims it will help you get pregnant, but because it will help calm your system while you're dealing with this crisis. I did have a major criticism of this section: Domar is very quick to dismiss meditation as a helpful technique for overactive minds. She encourages you to try another relaxation technique instead. I don't know anyone who doesn't have an overactive mind -- it is the very nature of minds -- and the beauty of meditation is that you learn how to calm it. So, please don't give up on meditation!

The second part of the book deals with very specific IF issues. The chapters I found most useful were how to deal with handling IF at work, and the chapter on spirituality and IF. Both were full of compassion and practical advice for working through the problems IF poses.

The last chapter of the book is about how to deal with it when treatment fails. Domar discusses adoption, egg or sperm donation or living child-free. Again, she does so with compassion and practical advice.

Overall, if you are dealing with IF, I highly recommend this. A final note: the book, like most on this topic, is primarily directed at women, though I do think that men who read it would find it helpful.

View all my reviews

Tuesday, February 5, 2013

You Gave Me A Mountain

"This time, Lord, You gave me a mountain, a mountain you know I might never climb. It isn't just a hill any longer -- You gave me a mountain this time."  - "You Gave Me A Mountain," lyrics by Marty Robbins, sung by Elvis Presley

"There is sorrow beyond all grief which leads to joy and fragility, out of whose depths emerges strength." - Rashini

I have had a lot of reproductive disappointments lately. It feels unbearable to write about them, but when I realized I haven't posted anything in almost a month, I knew why: this is what is going on, and I'm not in the mood to talk about it. Yet, this topic feels like a blockage, and until I write about it, I can't write about anything else. This sucks unlike anything else I've ever been through. I don't want to make it sound like I've been on death marches, sex trafficked, or anything else truly horrific, but for a privileged white girl, I have had my share of genuine tragedy and heartbreak, and infertility (IF) exceeds it all. Perhaps it's because IF touches on such deep, personal longing: religiously and culturally, most people have been inculcated with a deep desire to have children. Hell, if you are from a Judeo-Christian background, it's the first frigging commandment. If I were inclined, I could write a separate post about what IF has done to my spirituality and relationship with God. It aint pretty. Add to that the intense biological drive to propagate, and you have a potent mix for being really fucked up if things aren't working in the reproduction department.

When I had my miscarriages, I was shocked at the insensitivity of other infertile women who said, "Well, at least you can get pregnant.  I haven't been able to do that." I still stand by the insensitivity of expressing that comment to someone who has lost three babies, but from where I sit now, I agree. For unknown reasons, I have gone from the camp of the super-fertile to the "...and to think, I wasted all that birth control!" camp. When you can get pregnant, there is still hope that this pregnancy will turn out ok. Now, I understand the frustration of getting yet another period when you don't want one. This is worse.

That leads me to another point: I have had to eat some real humble pie. My IF journey has led me to feelings and behaviors that I thought I was above, and I find myself experiencing many of the things I judged other infertile women for. For example, I used to think it was strange when someone told me she couldn't be at synagogue with all the kids. Now, I totally get it. Not wanting to be around pregnant women? Check! Not wanting to be around babies? Double check! Feeling like a playground or Facebook is an emotional minefield (especially around the anniversary of Roe v. Wade)? Check! I actually hid a new parent's Facebook feed recently because all she posts about is her new baby (kudos and thanks to my other friends who are new parents who do a great job balancing info about parenthood with other things! I love you!) In a strange way, I feel like the Universe is giving me a dose of all the things I used to be judgmental of. I assure you, I'm not anymore. I have also learned that the IF drugs, with the intense bloating they cause, make you look pregnant, so I shouldn't assume anyone is.

Maintaining perspective on this problem of IF is not for the faint of heart. It is easy to let it consume you. One of the common ways to try to balance the pain is to look at what is going right in my life, which, thank God, is a lot! Most importantly, I get to wake up every day next to my best friend and partner, whom I'm still madly in love with. I think marriages like ours are rare. My life is full of blessings! Yet, I have to be careful with this tack, because I also use it as a way to negate my feelings of intense sadness. Yes, life is beautiful, but it still feels for both of us like our family is incomplete. For these reasons, it feels like this method of focusing on the positive isn't an authentic or truly useful way in and of itself for me to work through this problem.

I did have some relief this morning when I did a guided tonglen practice led by my meditation teacher, Tara Brach. This is a powerful practice that helps us connect with the suffering of ourselves and others in a meaningful, compassionate way. I found it very calming to view IF as a wave held in the greater awareness of my life as an ocean. To paraphrase Tara, when you're aware you're the ocean, you're not as afraid of the waves. I also like the tonglen practice because an integral part of it is focusing on the suffering of others, and in doing so, it feels like offering a prayer on their behalf.

Ok. I have been sitting on this post for a week, and can't think of anything else I'm willing to commit to the Internet, so here it is for now.

Monday, January 7, 2013

Elvis Birthday Shabbat

"When I was a child, ladies and gentlemen, I was a dreamer. I read comic books, and I was the hero of the comic book. I saw movies, and I was the hero in the movie. So every dream I ever dreamed, has come true a hundred times... I'd like to say that I learned very early in life that without a song, the day would never end. Without a song, a man ain't got a friend. Without a song, the road would never bend, without a song. So I keep singing a song."  - Elvis Presley accepting the Jaycees' award for being one of the Ten Outstanding Young Men of the Year,  Jan. 16, 1971 (video here)

David and I decided to finally give Elvis Presley his glory and celebrate his birthday. Although he would have been 77 on Jan. 8, we knew we wouldn't get many people here on a weeknight, and decided to throw a traditional Shabbat (Sabbath) dinner in his honor on the Jewish Sabbath. After all, the King had Jewish ancestry on his mother's side, so we knew he'd approve.

I have a genuine love of Elvis after three years of employment at Graceland, and I am always eager to initiate the uninitiated. I planned a traditional Southern meal for the occasion:

"Burning Love" Fried Peanut Butter and Banana Sandwiches
"Fever" chorizo beef sausage

Glady Presley’s Corn Bread

"Love Me Tender" BBQ Chicken

"Too Much" Memphis Coleslaw
"Viva Las Vegas" Lady Luck Black Eyed Peas

"Polk Salad Annie" Collard Greens
 and Kale
"Hound Dog" Baked Hush Puppies

"You're The Devil in Disguise" Pineapple Ice Box Cake (photo and recipe)

David, our sommelier, chose Clos Bel-Air's Montagne-Saint-Emilion wine to accompany our selection of beer and Coca-Cola. I'm not sure what that wine had to do with Elvis, but it is from France, and I'm sure Elvis French kissed!

Thanks to the handiwork of my sister, Lillie, we had awesome looking decorations including Elvis place mats and a kick-ass centerpiece for the table. David strung up Lillie's garlands and festive Elvis Birthday lights. You didn't think we'd leave the throne room undecorated, did you? The rock n' roll gods blessed us, and my mom sent some Elvis-themed gifts, including a Blue Hawaii tray that we used as a challah plate, a little pink Cadillac, and cups and napkins. Seriously, opening that box was better than Christmas, and I'm pretty sure this was the first time in history that someone served challah on a Blue Hawaii-themed item.

The meal was meant to be tasty, celebratory, informative, and, above all, FUN. To that end, we interrupted dinner several times to engage in some Elvis trivia questions ranging from the mundane ("How many movies did Elvis star in?" Answer: 33), to the racy ("Why was Priscilla Presley embarrassed to go to the Walgreens in Memphis?" Answer: because everyone knew why she was buying up all the Polaroid film, according to her book "Elvis & Me").

One of the most enjoyable parts of the evening for me was the Elvis Presley sing-a-long we did. David and I chose five of Elvis' most famous hits spanning his career and printed selected lyrics on a song sheet, which we all sang. What we lacked in talent we made up for in enthusiasm!

I had a huge smile on my face all night. My guests seemed to have a blast and enjoy dinner, and I have no doubt that all of us learned something about The King. Three days after the meal, I'm still getting very warm texts and emails from people who were here. The reason it was so much fun is that our friends got really into it, for which I'm thankful. They patiently listened while I regaled them with tales of working at Graceland, the best job of my life.

We wanted our guests to carry the spirit of the King into their life, so they left with a cute little Elvis magnet as a party favor.

There is little doubt that thanks to the success of this endeavor that Elvis Birthday Shabbat will be an annual event. What remains to be seen is whether it will stay small or morph into a bigger party so we can share the gospel with more acolytes. Long live The King!

Friday, December 21, 2012

Bringing A Snow Cone To Hell

Kacy and I have visited our first hospice/Transitions* clients together. They are three adults in a facility for people with dementia -- a small neighborhood home in my metropolitan area. Severe dementia can be a primary diagnosis for hospice, though two of my three clients also have cancers. The setup for our visits is most of the house's residents are gathered in the living room, and I visit with all of them who are alert even though my primary focus is working with the three clients of my hospice agency.

The title for this post came from a comment my husband, David, made when I told him about my first visit to the facility. It seems to have very little stimulation for residents, and they really reacted to the presence of the dog. "It sounds like you brought a snow cone to hell," David said. The Transitions client is the only one who can still speak, but she has no interest in Kacy or me and sleeps all the time. The first hospice client, "Lila," is very awake and alert and took a keen interest in Kacy. She pets her quite a bit, and interestingly, when I gave her a stuffed animal to hold when another resident was holding Kacy, she threw it down and gave me a look like, "You are not going to fool me with a stuffed animal!" Lila spends a lot of time picking Kacy up on the couch and putting her back down again, as well as clipping and unclipping her lead to her collar. Lila, Kacy, and I also take walks around the facility together. On our first visit to the facility, a nurse and social worker from my agency met us and said that Lila was far more animated in Kacy's presence than she normally is, so that was gratifying.

The second hospice client was even more interesting to me. "Dr. White" is a 60-something year old physician also with advanced dementia. He also no longer can speak and has a very flat affect, until he gets a hold of Kacy. Seeing him transform with her is almost as close to a miracle as I've ever witnessed. He strokes her and touches her, burying his face in her fur. Most touchingly, Dr. White kisses Kacy so tenderly. This is a man who has lost the ability to express affection in any other capacity, according to his caregivers, yet he kisses the dog. The first time I saw this I almost burst into tears on the spot, but luckily held it together.

I was thinking about why animals are so great for dementia patients. Dr. White had small dogs earlier in his life, so maybe holding Kacy triggers warm fuzzies for him. Additionally, it occurred to me how hard it must be if dementia patients want to speak. There is a chance they want to, but just can't. Me talking to these patients puts an expectation of a response on them; Kacy demands no such response. Dr. White does not want to let go of Kacy when she's there. When I separate Kacy and Dr. White so she can visit the other residents, I assure him I'll bring her back to him, and whenever we leave I tell him that I'll return with her next week.

Whenever I tell people I'm a hospice volunteer they ask me if it is depressing. I am new to this, but at this point, the severe dementia I work with is far sadder to me than someone dying from disease.  Dementia patients return to a childlike state, and I see even well-meaning caregivers treating them like toddlers in adult bodies, and it makes me very sad. Dementia ages people severely: both of my hospice clients are in their 60s and look much, much older. There is a 65 year-old woman in the same facility (with a 25 year-old daughter) who became symptomatic at age 55. The patients in the facility I visit are safe and clean and well-fed, but I don't see a lot of effort going to keeping them stimulated. Perhaps this is more than we can ask staff earning minimum wage to do. That said, I handed Dr. White a ball of yarn to play with, which he did eagerly. This is the kind of accessory the facility could keep around, but doesn't. Witnessing patients transform when they are handling Kacy is, as I said, as close to a miracle as I've seen. I have no illusions that the patients remember me the second I walk out the door, so I am not getting to build intimate relationships with these clients. However, I also have no doubt that for the time the dog is there, their lives are better for those moments. For that reason, it is a privilege to bring a snow cone to hell.

*Transitions is a pre-hospice program for patients who are very ill but who don't yet meet hospice criteria.