Any Questions?

“You will be 100% infertile… Any more questions?”

The words reverberated in my skull as I took the receipt from the hospital parking deck turnstile. My anger radiating through my knuckles as I gripped the steering wheel tighter with each passing minute. My vexation only heightened by the fact that I just paid $15 for parking. All to be nonchalantly reminded that my new treatment plan would leave me unable to conceive children on my own.

I’m not sure if I expected warm reassurance that everything would be OK or even a sympathetic frown as a follow-up to the verbal dagger I had just received, but I was hoping for more than an indifferent:

“Any more questions?”

As in, “Are we done here?”

As if the summation of my reproductive future had been determined. The prophecy written.

My anger continued to build with the more distance I put between myself and the examination table. Anger rooted in my doctor’s nonchalance in the concern for my fertility as a 25-year-old female who has yet to even start to contemplate having a family.

My doctor tossed me a grenade disguised as an egg, and I extended my hand to receive the seemingly innocuous offering.

I didn’t know the pin had already been pulled.

I didn’t know I needed to ask if it had.

Perhaps it was the general sense of nonchalance about the matter that left me wondering, as I sat on the examination table, if I was maybe misunderstanding what I was being told. Maybe I was the one overthinking what weight this bore.

My doctor would surely be alarmed if this was an issue….Right?

He was, after all, visibly panicked when we discovered that my initial treatment wasn’t working and the next option would require a stem cell transplant.

That grenade wasn’t disguised, however. Merely dropped into my family’s lap before he gave vague answers to our questions and exited in a huff of concern. Leaving us to sit alone in what can only be described as a storage closet, scrambling to put the pin back into its vessel. Scrambling to fix me.

Perhaps this promise of infertility wasn’t as big of a deal as some piece of me felt. A piece that had been allowed to remain asleep, apathetic to its existence. Until now.

After all, I was being told my cancer was diversifying its portfolio at the expense of my life. Instead of being concerned about having a future family, I should just focus on having a future.

It took me a much farther drive than the profiteering parking deck to understand that regardless of my medical team’s personal detachment from the matter, this very nonchalance in the threat to fertility that adolescent and young adult patients face is one of the reasons only 46% of AYAs are informed of the impact their cancer treatments may have on their future.

46%.

For some, perhaps this news isn’t startling. At one point in my life, it wasn’t.

But as is often the case with Cancer, the veil of naiveté was pulled back and the percentages are no longer merely symbols typed on a page or placed delicately over an infographic. They are people. And I am one of them.

I would have been on the wrong side of that 46% if I hadn’t connected with a therapist three years prior who happened to specialize in fertility counseling.

I would not have known to ask about the risk my treatment posed to my fertility without my therapist’s guidance. And my initial medical team showed no signs of filling in the blanks my ignorance created.

Perhaps it was my lack of babysitting an egg with a classmate or the fact that family planning was not high on my priority list as a 25-year-old female growing up in a culture dominated by money, success, and the side hustle, but I lacked the awareness of how closely intertwined the webs of my reproductive health and cancer treatment were. And the fate of my potential children rested squarely on the shoulders of someone enlightening me.

Oh how delicately our futures rest on someone having a good day.

I think quite often there is a weight placed on patients to be grateful. As if in facing your mortality you should come out on the other side of it thankful for getting one more day. There is an externally perceived shelf-life on your resentment and bitterness for all you might have lost, and it is much shorter than that of gratitude.

And it is reasoning such as this that only helps to perpetuate the paltry numbers of AYA patients who are notified of the additional disruptions their cancer will cause. The part of the iceberg that rests quietly beneath the surface. The part that an unfortunate majority of doctors don’t think is worthy of warning. Or perhaps simply don’t even think to address. Blinders to the peripheral damage caused in their quest to vanquish cancer.

As my doctor confirmed the inevitable scrambling of my ovaries, my brain and heart tried to simultaneously grasp what this prognosis meant.

I’m still not sure we know.

The sound of the crepe paper crinkling underneath me as I shifted uncomfortably on the examination table filled the silence. A silence that felt as heavy as a quilted balloon that pressed against every surface of the room as it absorbed the last bit of air.

So there I sat, holding an egg in my hands that I was beginning to realize was more fragile than I thought.

An egg whose shell has thinned even more in recent days, as the conversation of reproductive justice heads down an uncertain path. A regressive journey that would once again skew access and fog the window of our futures. More webs intertwined in ways not easily seen.

As patients, the barrier to entry of freezing our eggs/sperm is already high. Outside of the inherent lack of conversation surrounding our options, fertility preservation is costly. Another bill to add to the growing pile.

Contemplating the price tag on a family that you don’t know whether you want is a concept for which words fail me. They fail to express the guttural churn and inflamed heart that press against one another as you grasp for the sprout of a seed that was planted mere moments ago by the promise of its loss. The equivalent of words being trapped in your throat as you tilt your head back to scream towards the sky, for you are no longer rooted in the present as your mind races back and forth between your future and the ideals you’ve previously held. Your esophagus vibrates in a mix of shock, fear, judgment, relief, anger, confusion…

Yet there is only silence where the sensation is deafening.

I never thought this would be a contemplation I would have to make, but it was one that led me to debate whether I should preserve my fertility. I was making a decision for a future self with my current sense of what was important to me. A decision that required me to foot the bill with savings that seemed to be dwindling at a faster rate in recent weeks.

And truthfully, I might not have frozen my eggs if it hadn’t been for the generosity of organizations like Team Maggie For a Cure and First Steps. Organizations that understand the importance of fertility preservation for cancer patients.

And though these resources are few, those contemplating fertility preservation due to their cancer diagnosis at least have potential access to some financial support. I can only give you the viewpoint of a female cancer patient who at least had a little rainy-day savings and a couple financial assistance applications with which to contemplate the preservation of her fertility. Not everyone has the luxury of contemplation.

Contemplation implies a choice, an ability. The margin of ability shrinks if standards of practice that once propelled the industry are re-evaluated, potentially narrowing even further the avenues of family planning for those whose womb-fruit is not self-pollinating. Potentially narrowing the luxury of contemplation.

I hope we do not achieve these potentials, possibles, and maybes.

I hope the eggs we cradle in our hands do not detonate. I hope the shell of choice does not shatter.

It has been almost four years since I was tossed that egg, since the white crystals holding back the liquid below the shell’s surface began to fracture at the weight pressed upon them.

There are days I wonder if my future children are sitting in a freezer or still tucked away safely inside me.

There are days I wonder if my identity as a parent will end at “Aunt.”

There are days I wonder if I truly am infertile. If I will discover that the ripples of my cancer could not be contained within the few years surrounding my treatment.

There are days I don’t know.

There are days I do.

Any more questions?