Both Sides of the Coin

Who doesn’t like a snow day, or two, or three….?I think I’ve done  a good job making the most of mine: slept late, drank hot chocolate, caught up on TV series, made waffles.  I don’t have any real affinity for snow in and of itself. My parents never took me sledding – not a complaint, just a fact- and I have no real love of snowmen. Tommy, my Hungarian husband,  believes that the snow is not fun here, it’s better in Hungary but here it is just a nuisance.

To be sure the Jerusalem municipality did a dismal job of cleaning up the snow and all that came after:

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Though I like these relaxing days for what they are: me days!

Then I go to Facebook and I see the pictures my friends have posted: baking cookies, sledding, building snowman, making memories – all of it with their children and it looks like so much fun, maybe more fun because it is with kids. I can’t help but wonder when it will be my turn to create these moments with my children? I even find myself hoping that this is not a one time event for Jerusalem – though please not in the near future!

I ask Tommy: “Will we take our kids to play in the snow one day?’

“Of course,” he answers, “in Hungary.”

I know that there are two sides to this story. Parents are at their wit’s end trying to figure out what to do with their children going into the fifth day straight of school closures. I’ll wake up at 9:00 am tomorrow morning – an hour that parents of  young children can only dream of – I won’t have to deal with children climbing the walls. Childcare is not a concern for us on those days when Tommy and I need to work and schools are on vacation. We are flexible and free to do what we want when we want to and we enjoy it.

Still, one day I plan to take my kids sledding, perhaps in Hungary.

Reassuring Information

The following is an actual conversation I recently had with a friend, I find it very telling:

      Friend: “So who is your doctor?”

      Me: “Dr…..”

      Friend: “Oh, he got all my friends pregnant!”

Can’t beat a man with a reputation!

Closed For The Holidays

There are a few things about living in Israel that never get old: the buzz of  Jerusalem on  a Friday morning, buses that flash the message “Shanah Tova” or “Chag Sameach,” The Rosh Hashanah and Passover bonuses that I receive at my job; I love living in a country with a Jewish culture.  Admittedly, I maintain a strict observance of all Thanksgiving related practice – minus the football- and there is still a warm place in my heart for the movie theater on Christmas Eve, but there is nothing like Israel during the holidays.

Israelis begin their preparations for the fall holidays at some point in mid-August, it’s about that time  when they begin to throw around the phrase “Achrei HaChagim,” (after the holidays). Anyone who has spent a significant amount of time in the country understands the implication of this phrase: everything gets put on hold until after the holidays, no exceptions. There are particular rules for this “season” and learning to accept rather than fight the trend will make for a much happier holiday season. To name a few:  don’t even think about trying to start a new job (you are much better off taking a vacation), assume that all government offices will be closed for two-thirds of this period, never start any type of home repair that will take more than a day’s work by any contractor – if you do, you will have only yourself to blame. In short, whatever it is that you figured was oh so pressing that it couldn’t wait, will have to wait until after the holidays.  Over the years I have been on both the giving and receiving end of this phrase, it’s all part of the culture that I love.

Last year, right before Rosh Hashana,  l learned that fertility clinics in Jerusalem, and possibly other parts of the country, basically shut down for the entire month Tishrei. A nurse told me in passing and I didn’t give it much thought; we were still in the beginning stages of the fertility treatments- tests and IUIs. I was prescribed drugs that stimulated the  development and release of multiple eggs and told  that if  I were  to ovulate over a holiday, then we should try the old-fashioned way. The stimulants at least  increased the chances of conception. At the time I thought to myself, by next year we’ll be pregnant so there was no need to worry (I was so naive!)

Yet in the blink of an eye a year passed and we were well into the IVF process ready for another  transfer of frozen embryos, but that would only happen “Achrei HaChagim.” When you think about it, it does make sense, IVF is an extremely time-sensitive process and there are too many days when the clinic would be closed. It is easier to slow things down to a full stop and give everyone, staff included, a break. Yes, we could have looked for a private clinic or another option that may have been open, but in the end we decided to take a break and wait. It wasn’t ideal, but also was not horrible to escape the process and enjoy the holidays; our embryos remained  safe and sound in the freezer.

Israel is back in full swing and we have returned to our regularly scheduled fertility treatments.

Battling Bureaucracy

It is a fact of life and unavoidable; at one point or another we all encounter bureaucracy. If the DMV is the worst of it, consider yourself lucky! Israel thrives on bureaucracy and Israelis spend significant amounts of time and energy negotiating their way through oceans of paperwork and endless lines at numerous offices – welcome to Israel. Over the years, I have developed a few strategies for dealing with this reality. It all begins with acceptance, don’t fight the  bureaucracy, instead focus on your goal of getting whatever you need. With a little persistence, you can almost always get what you want or need from the system.  Second, the fax machine is your friend and can spare you hours on hold or waiting at an office. Finally, be sure to bring something along  to keep you busy as you wait. When I arrived in this country ten years ago, I had only the newspaper and some mediocre games on my phone to keep me entertained in a long line; today my smart phone offers me infinite opportunities to mindlessly pass the time.

Strategies aside, I never expected to encounter bureaucracy while trying to conceive. I had always just assumed that it would involve a bit of fun and the need to pee on a stick (POAS).  Eventually,  I learned that it might not be quite that simple for us,  but instead of bureaucracy, my associations with fertility treatments included tests, injections, examinations and stirrups.  Therefore, allow me to set the record straight, there are many forms and documents that must be submitted, signed and approved. The bureaucratic elements of fertility treatments are particularly difficult to maneuver because often both emotions and hormones are running high. I have dealt with lost folders and numerous tests that have simply disappeared or were not recorded; all of this can be resolved, but is nonetheless frustrating.

Tommy and I were introduced to the web of  medical bureaucracy well before we began fertility treatments. About two years ago,  I had been told that my cysts could become cancerous and needed to be removed as soon as possible. The doctor wrote an order that I be hospitalized and informed me that I could simply call a hospital and schedule the surgery (he was not a surgeon).  He was correct and though Tommy insisted on vetting the doctor who would perform the surgery, the process was easy. Probably too easy.

The final step was to obtain a form from my insurance company confirming that they would pay for the procedure. It is a standard form and, in most cases, easily obtained. I faxed a copy of the doctor’s order to the insurance company’s administrative office – it  seemed to be a redundancy as the order was already in my electronic file and had been ordered by the company’s employee. The insurance company informed me that they could not provide me with their commitment to pay without a written order from the hospital. That seemed reasonable so I contacted the hospital. Only they told me  that they could not provide the information because they did not order the surgery!

A game of ping-pong began only I was not having much fun. After endless phone calls that led nowhere, I decided to show up at the hospital and find someone to resolve the problem. I spoke with the same nurse who already insisted over the phone that it was impossible to provide the information. She assured me that the insurance company was mistaken and had an animated phone conversation with them regarding the situation. She begrudgingly signed the form and the insurance company committed to pay.

My persistence had paid off and proved that I was unstoppable, but the twist would come two days before the scheduled surgery. I went to the hospital for a series of tests and to meet with the surgeon. I had a new set of blood tests and another ultrasound and handed it over to the surgeon.  He reviewed the file and made it clear that he disagreed with the diagnosis. The cysts were most definitely not cancerous, they were endometrioma and they were not especially big. Since we had yet to try and conceive, there was no reason to remove the cysts. The surgeon told me that he would not have approved this surgery and it is unfortunate that he was not asked to approve the surgery – touche!  He wrote a very direct letter to my physician explaining that there was no reason to suspect cancer (my doctor conceded that he was right). Last but not least, he told Tommy and I to get busy; that prescription was easily approved.

Props to Israel

I moved to Israel nearly ten years ago and it was a news item.The article is not entirely accurate. My first trip to Israel was after 10th grade and as part of a trip run by Young Judaea not Akiba. I went to college at both Columbia University and The Jewish Theological Seminary. My father’s name is spelled with only one ‘l’ and with an ‘a’ not ‘e’.  In any case, it is more or less accurate. It seems that a decade ago I was most concerned with missing the US and my family and friends:

“I’m sad to leave my family,” Appel said. “But my hope is that I will have created a home there, a sense of community and family, and that I will be making a difference in Israeli society.”

Today most of what I had hoped for has come to fruition. My brother and his family now live in Israel, I work in education, I met a charming fellow who became my life partner and I have made some wonderful and deep friendships. As for Israeli society, that is the topic of another blog by someone who is far more gifted  and brave than I.

Perhaps the greatest testament to my acculturation to Israeli society is that I have  developed a love-hate relationship with this country. It annoys me to no end that Israelis are incapable of waiting patiently  for their turn in a line – it is for this reason that I do all my grocery shopping online – or that nothing is ever anyone’s fault. I find myself disappointed by many of the realities in this country when I consider all of its potential (a sentiment often expressed by my teachers in high school about me!) Ten years later, I remain here, because this place is my home and because I hang onto optimism about the future – or at least I try.

Despite my rant, Israel deserves some serious props when it comes to the issue of infertility treatment. This is not to say that it is perfect but I have had a very good experience so far. To begin with the National Health Insurance Law offers its female citizens who are 51 and younger coverage for infertility treatment for two successful pregnancies. This is true regardless of a woman’s marital status, although I am fairly certain that some clinics will only perform IVF on couples who are legally married (but I could be wrong). Tommy and I did have to provide a copy of our marriage license before we could start IVF. There are support organizations for single and even religious women who wish to become mothers without a partner. The laws are also quite progressive when it comes to same sex couples. There is even fertility tourism to Israel.

Female Israeli citizens receive their coverage and treatment through the health insurance provider that they choose but the companies are more or less the same.  Everyone knows that these treatments can be quite costly in most parts of the world, which is why it is remarkable that in Israel citizens receive these treatments at reasonable prices. For example, a drug that would cost me $300+ for one injection in the US, comes to 80 Shekel (about $20) with the coverage that I receive.  In the US coverage varies according to state and that seems arbitrary to me. I can only imagine how much more difficult this process would be if trying to get pregnant were to become a financial strain.

Beyond the policies and finances of it all, my encounter with the nurses and doctors who deal with infertility has been comforting and encouraging. There is sensitivity to the process and the emotions that it involves, as well as a willingness to go the extra mile  for us and our care. Mostly, it is comforting that every conversation ends with the words, “good luck!” I feel that they are helping and supporting us in achieving our goal. Throughout this process a kind and positive attitude has made all the difference.