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My Journey Through Infertility, Loss, and Ultimately, Motherhood

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“Is it your first?”

The question – albeit innocent and not unusual – throws me off guard and I hesitate.

What do I say – or what shouldn’t I say?

Part of me is inclined to be glib and simply respond with a ‘yes’, but deep down inside, I yearn to tell her more.
Standing before the Wellesley student, my mind flashes back to what I was like some sixteen years or so ago. How naïve I was at the time. What hopes and dreams I had. When I was her age I had my life all planned out – or so I thought: I would graduate, go on to graduate or medical school, marry the man of my dreams, and have a boy and a girl – all before the age of 35.

Max’s chatter quickly pulls me back to reality and I lean down to hand him a snack.

“Umm…something like that” I respond. Puzzled, the girl politely smiles and, without a word, continues to walk towards Tower Court dorms.

I turn and look back for a few seconds as she moves on, compelled to stop her and provide some more of an explanation, but then change my mind.

“Now Rosa,” I remind myself. “Remember what Pat said, ‘not everyone needs to know’.” Words of wisdom thanks to hours of grief counseling with my husband Glenn.

I pull under a patch of shade on Severance lawn, a perfect place to let Max roam freely for a few minutes.
I watch as my 3-year-old happily scrambles over to a small pile of fall leaves and focus back to my encounter with the student just moments earlier.

I could see why anyone would pose such a seemingly benign question. What else would one ask a young mom walking with her kid across Wellesley’s campus? Before I was a married woman of child-bearing age, I myself had asked the same question to countless of women I ran into on campus with their little cherubs.

Little did I realize how much four simple words would later come back and affect me.

A gentle cool breeze whistles through, causing the large, drooping branches of a nearby willow tree to softly brush across and tickle Max’s face. He squeals in delight and loudly beckons for it to swing back. I smile at the sight. What a beautiful and happy little boy, I think to myself, and to think…if Matthew and Katelyn hadn’t died…I never would have had him.

The twins were the result of our very first in-vitro fertilization (IVF)1 attempt. Had they survived five years ago, Glenn’s and my plan to have two children would have been done. No more shots, ultrasound scans and blood tests. Or so I thought. After Katelyn and Matthew died, we went in for IVF #2, which failed. Fortunately, less than a year later, our third time was a charm.

Since Max’s birth however, Glenn and I never fathomed that we would endure six additional IVF cycles in attempt to provide our son a sibling. In the end, my body conceded defeat and surrendered to the ugly battle.

For weeks I was in mourning. Next to losing the twins, it was the second darkest period of my life. This time, I was not grieving over lives lost, but I might as well have been. Learning that our last IVF had failed was akin to hearing a death sentence for any more attempts for another biological child.

I had used up my chances [generously] provided under Massachusetts’s law. Adoption would be our only remaining alternative to extend our clan.

Glenn and I will consider officially announcing this decision to our extended friends and family at the next formal gathering. The last time we had all congregated under one roof was last year for Thanksgiving dinner, a bittersweet time for us. Around this time each year, I need to remind myself that we have a lot to be thankful for. We have a roof over our heads, we have our marriage and, most importantly, we have Max. Yet on the other hand, the occasion is tinged with sadness, as it is a yearly reminder of what we lost and everything we went through just five years before. The dates are indelibly etched in my soul:

November 9, 2004: Matthew and Katelyn are born.

November 10, 2004: Matthew dies

November 27, 2004: Katelyn dies

Come this November 2009, the twins would have turned five years old. It’s hard to believe. Pat was right. In the beginning, mourning over the loss of a child – or children – in our case – is like a wound that never heals. Just when it starts to scab, it rips off and bleeds non-stop. With time, the scab eventually stays and ultimately, it does heal. However in the end, what remains is a scar.

A permanent reminder of what we endured.

I shake my head at everything Glenn and I have been through: renovation of a 1780 farmhouse; job lay-offs; six years of infertility; the births and deaths of our twins. Together, we have experienced more in our eight years of marriage than most couples experience in eighty years. The words “for better or for worse” were never more tested.

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Our journey into the world of infertility began in 2003. At thirty-one years old, I had just finished graduate school and was six months into my new job. Glenn and I had been married for almost two years and were now ready to start a family. Month after month, we tried but to no avail. At first, I attributed my not getting pregnant to other stresses in our lives. We had been house hunting and weren’t very happy at what we saw. In June, we stumbled upon a house in South Natick, just three miles from Wellesley campus. It was old and in desperate need of repair, but we saw past that and all its potential. Its one-acre yard was ideal for our dog and future kids, we liked the neighborhood, and it was closely accessible to all the major highways. We put in an offer and it was accepted. Five days before the purchase and sale, Glenn was unexpectedly laid off. Despite it all, we sailed through the paperwork and still got the house. That August 2003, we moved into our very first home.

For the next eight to nine months, I went to work while Glenn kept busy with projects around the house. To our dismay, the list of things-to-do continued to grow with each passing week. Wallpaper needed to be stripped, crawl spaces reclaimed (from rodents), walls patched or rebuilt, electricity updated – the inventory went on and on with no rest in between. I will never forget the day Glenn called me at work seething. He had been moving what had been the previous owner’s old washing machine in the laundry room and managed to put his foot through the floor. Evidently, a leaky pipe had slowly rotted away that area. He now had to drop the other three projects he was in the middle of and switch gears to this one. “What have we gotten ourselves into?” We thought.

By January 2004 and following my thirty-second birthday, I decided to seek medical intervention. We still were not pregnant and I did not want to rely any more on Mother Nature. I began to see an obstetrician (OB) at a small practice in Wellesley. I felt all the people there were attentive, particularly the nurses, and helpful in my endeavor to get pregnant. At this practice, several rounds of less-invasive means of assisted-reproductive technology (ART) with Clomid [2] and intrauterine insemination3 (IUI) were employed. When those all failed, I was referred to a reproductive endocrinologist (RE) – the “big guns” as one nurse put it – at a nearby hospital that specialized in infertility. I had now graduated to the land of high-tech medical assistance, where IVF and dozens of other 4-letter infertility acronyms (i.e. GIFT, ZIFT, ICSI) abound.

With the support of the RE and her incredible staff, as well as close family and friends, Glenn and I navigated through the emotional and physical highs and lows of the IVF process. Things began to improve two months later, in February, when Glenn landed a job in a small start-up company. Our outlook in life started to pick up. In May 2004, we underwent our first IVF procedure, deciding at the time to implant two embryos to increase our chances of a pregnancy. Imagine our surprise when, at our two-week pregnancy test, my hCG4 levels registered in the thousands, a likely sign that not only were we pregnant, but pregnant with twins. In the weeks that followed, additional ultrasounds confirmed that to be the case. Again, Glenn and I went through a myriad of emotions, this time from complete disbelief to giddy excitement and fear. We yearned to be parents, but could we manage two babies at once? Never in our lives did we imagine being successful on our first IVF attempt. We had friends who had tried for months – even years – and figured the same would happen for us.

Instead, we hit the jackpot in the IVF lottery.

Pre-IVF, we had assumed that the time it would take to get pregnant and carry a baby to full-term would allow us plenty of time to complete the major renovations on the house in time to welcome our new addition. Now we had just nine months to have the house ready for not just one – but two babies! With my RE’s mission accomplished, I was released from her care and returned under the watchful eye of my original OB.

That September, a 17-weekultrasound revealed that we were having a boy and girl – just what I had always dreamed of having – one of each! Icould not have asked for a better pregnancy. Absolutely no morning sickness, nausea,vomiting – nothing. Even at my 23-weekultrasound on November 2nd I felt fine. With Glenn by my side, the ultrasonographermeasured the babies and said they looked great. The only thing out of the ordinary was the fact that she had some difficulty seeing our son, as he was extremely low in my pelvis and asked that a nurse come in to check me. A nursecame in and did a manual exam and said that my cervix felt fine, nice and closed, and sent us off. We never saw the OB during that visit, but left the practice assured that everything was okay.

As we were told, my cervix was closed.

That all changed exactly one week later on November 9, 2004. I had noticed a little clear discharge in my underwear mid-morning while at work and Googled it at my desk to see if I should be concerned. Without any other symptoms, most websites said it waslikely a sign of a possible vaginal infection and to notify the OB. Chances are I would be prescribed an antibiotic and sent home. I called officeand was told to come in at 3:45 pm that afternoon. .

At 3:40 pm, I walked into the practice and checked myself in at the registration desk. I was in the waiting room for about a half hour when I had my first contraction. Although I didn't know it at the time – (it just felt like a lot of pressure down there) – and went into the bathroom thinking it was just a bowel movement. It wasn’t until I looked down that I saw some more discharge and a small tinge of blood.

Alarmed, I went straight to the registration desk, informed the receptionist that I think I just had a contraction and asked to be seen immediately. It was now 4:15 pm. Luckily,the samenursewho had examined me the week before was standing right next to me and immediately brought me into a room. I hopped up on the table and resumed the position. She peered down, winced, and then closed her eyes.

“I am so, so sorry,” she whispered, “but you are fully dilated and your membranes have ruptured. We need to deliver your twins right away. I’ll be right back.” She ran out of the room to the nurses’ station where I could hear her order someone to call for an ambulance STAT. Shocked, I began to bawl hysterically. Tears flooded down my face as lay on the table, listening to the nurses scurry about outside. Staring up at the ceiling, my mind screamed inside for my body to do something – anything – to stop this from happening. Not now! It’s too early! I’m only 24.5 weeks! Minutes later, I could hear the ambulance siren, its wail getting louder and louder as it approached the building. As two emergency medical technicians (EMTs) hoisted me onto the gurney and wheeled me out of the building, a nurse tried to reachGlenn on his cell.

I wasimmediately rushed to the hospital and into an operating room (OR). Kerry, a nurse, stood to my left and held my hand as the anesthesiologist summarized the emergency Cesearean section that was about to take place. At 5:07 pm and 5:08 pm, respectively, my son and daughter entered the world.

Matthew Alexander Booma
Weight: 1 pound, 10 ounces
Length: 11 inches

Katelyn Elizabeth Booma
Weight: 1 pound, 6 ounces
Length 10.5 inches

Amidst my sobs, I strained to hear my children cry. Barely audible, I caught what sounded like faint mewing and squeezed Kerry’s hand as a team of neonatologists5 worked on each child. Out of the corner of my eye, through the huddle, I managed to catch a quick glimpse of one of the babies before a doctor scuffled over and blocked my view.

“Please save them!” I cried out repeatedly. “Don’t let them die!” I sobbed again hysterically, my grip tightened and I began to breathe faster. Kerry tried to soothe me with her voice but her words would not register. Then suddenly, she was gone and Glenn was in her place, donned head-to-toe in scrubs. He got there as fast as he could when he got the message, he gushed. Behind his surgical mask I could see the panic in his eyes. The sight of Glenn brought a sense of relief but another wave of hysterics.

“I can’t breathe,” I sobbed. “Our babies…!” The room started to spin. I was hyperventilating.

The anesthesiologist now stood over me and tried to console me. They were doing everything they can, he assured me. I needed to try and calm down. My breathing was so jagged that the doctors were having trouble closing my sutures. He turned to Glenn and asked whether he should deliver a little Versed6. Glenn nodded. Seconds later, there was complete blackness.

I awoke shortly afterwards in a recovery room with Glenn standing at the foot of my bed. Drifting in and out of consciousness, I again, asked about the twins. A neonatologist came in explained their condition. As to be expected, at 24.5 weeks or 5.5 months gestation, the twins were in need of a lot of medical attention. They were both stable for now, but it behooved them to be transferred immediately to a tertiary-level neonatal intensive care unit (NICU) at Boston Children’s Hospital just to be safe. Boston was fifteen miles away but we wholly agreed. Kerry said she would look into having me transferred in a day or so to Brigham and Women’s Hospital (BWH), which was next to Children’s to be near the twins.

Minutes following the conversation, two tiny isolettes were wheeled into the room. Glenn and I peered in to see up close, for the very first time, our son and daughter. Despite all the tubes and equipment attached to their bodies, each of them was no bigger than a loaf of bread. Their tiny, scrunched faces were barely visible from their respective pink and blue knitted caps. My heart melted and then it hit me: I was a Mom. Kerry stood behind Katelyn’s isolette and gently lifted the lid. Did I want to touch her, she asked? Leaning over the bed rail, I reached out and gingerly stroked Katelyn’s ear, then moved to her hand. It was no bigger than a nickel. Her Lilliputian fingers fluttered slightly as I brushed across them. Stay strong! I whispered. I then repeated the same process with Matthew, storing every feature of his I could into memory and of this moment. His coloring, I had noticed, was darker than Katelyn’s. All throughout my pregnancy Glenn and I had wondered how the children would turn out. With Glenn’s fair skin, blue eyes and sandy brownish-blond hair, and my olive skin and Asian features, we could only guess. Now, we could stop wondering. It was obvious that Katelyn took after her Dad; Matthew completely mirrored me. Glenn also said his good-byes and then they were wheeled away. For the next hour, I laid awake in bed listening as Glenn proceeded to call family members with the unexpected news. Finally, around 10 p.m. we both fell asleep.

No more than three hours passed when, around 1 a.m.,a Children's neonatologist calledGlenn to tell him to come into Boston right away. They were having trouble stabilizing Matthew's blood pressure and he was not responding to any medications. They did not think he would make it. Glenn immediately rushed over. For the next hour I stood helplessly by the phone while the nurses scrambled to expedite my transfer to BWH. “Please God!” I prayed over and over. “Please don’t let him die!” Sadly, it was too late. By the time I arrived in Boston, Matthew was gone. He had passed an hour earlier. My precious baby boy was on this earth for only ten hours.

There, in the Children’s NICU, I held my son for the very first and very last time.

My remaining four days at BWH was nothing but intense pain: pain from the C-section, pain from losing Matthew, pain from trying to remain strong for Katelyn – who was alive herself but struggling in the NICU. While still there, Glenn and I learned from a preliminary autopsy report that Matthew had died from sepsis. He had tested positive for Group B Strep (GBS)7.We later learned that chances are the infection came about due to my cervix slowly opening and a premature rupture of my membranes. As I processed this information, all I could think about was the ultrasound I had had the week before and the difficulty the ultrasonagrapher had experienced measuring Matthew since he was so far down in my pelvis. Was that the first sign that my cervix was incompetent? Was the nurse's manual exam sufficient? Why didn't the OB examine me to be sure?As a new mother, I immediately became racked with guilt for not protecting my children from harm's way. The emotional pain I felt right then and there was worse than any physical pain I had everfelt before. This should not have happened.

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While in the hospital,family and friends showered Glenn and me withconstant love and support. TheBWH and Children's staff were also extremely empathic in my care, and to this day, we cannot say enoughfor the social workers and nurses at both BWH and Children's NICU.Yet despite all of the attention, I still felt neglected. Why haven’t we heard from my OB? Both Glenn and I wondered. In the beginning, I shrugged the feeling off, convinced that at any hour I would eventually hear from her. She seemed so invested in my well being each time I saw her, I reasoned. Moreover, Glenn and I figured she had to have been apprised of the situation since it was two colleagues from her practice that had delivered the twins.

Yet the entire time I remained at BWH, not once did I get a phone call or visit.

On Friday, November 12, 2004, four days after giving birth, I was discharged home. Still no phone call. Pathetically, the closest thing I ever gotto a call was from the receptionist at my OB’s practice, asking that I schedule a wound-care follow-up appointment with a nurse. When I asked if I could be seen by my OB instead, I was informed that such an appointment was typically handled by a nurse. That’s when I lost it. Angrily, I summarized to the receptionist all the events that had transpired that week and demanded to be seen by my OB. She immediately arranged an appointment for the following week: November 19th at 2 p.m.

In the days leading up to the appointment, we still did not hear from my OB. By now, I never felt more abandoned. Not only had I lost a child; Ihad now lost respect for the person I once thought cared about me. Glenn was disgusted and beside himself. He could not wait to give her a piece of his mind. In all his years of experience in marketing medical devices and working with physicians both in the private and academic sectors, never had he seen such blatant disregard towards a patient.

November 19th finally arrived. As we drove, Glenn summarized to me what he would say to the OB once he saw her in person. He promised to remain calm and quiet during the entire appointment and let me do all the talking. However, he wished to express to her how we felt the practice, as a whole, had handledthe turn of events, and more specifically, our disappointment in my OB for her lack of contact. We agreed that he could get whatever he needed off his chest at the end of the appointment.

We further agreed that after this appointment, I was never to return to this practice again.

Walking into her office, my OB instantly showered us with condolences and sympathy. She seemed so sincere that my guard immediately dissolved.

Then she blankly asked how the twins were doing.

Glenn and I looked at one another, incredulous. She didn’t know Matthew was gone!The anger returned. Glenn’s face started to redden and he clenched his jaw. I, too, now had the urge to leap across her desk and throttle her. Nevertheless, I answered all of her questions, recounting from the very beginning what had happened that fateful day as she scribbled away in my chart.Towards the end of the appointment, just as we were about to leave, Glenn asked if he could say something. Most certainly, she replied. In a calm and controlled manner, he described to her how devastating these last two weeks had been for us, our disappointment in her for her lack of contact – from the time I was in the hospital up to the day of this visit – and the negative impact her treatment had added to the experience. Throughout his scolding, I watched as the color drain from my OB’s face. She stiffened, then pursed her lips and clasped her hands together on her desk. When he finished, Glenn and I waited in awkward silence, expecting to hear an apology. What we got seconds later was just the opposite. My OB cleared her throat and, without looking at me, coolly responded, "I called twice. I even have itdocumented here in your chart". That was all. Nothing else. We were stunned. Numbly, we walked out of the practice and drove off. Neither of us said a word the entire car ride back home. It wasn’t until we pulled into the driveway that the floodgates opened. Glenn held me as sobs racked my body.I never felt so used and betrayed.How dare she deceive me! I thought she caredabout me as a patient! I am so, so sorry Matthew and Katelyn for putting your fate in her hands!

And throughout all of this, there was still another person in this world to consider: our precious baby daughter. After my discharge from the hospital,for the next 2.5 weeks Glenn and I trekked everyday to Children's NICU to visit Katelyn. Like any micro-preemie, Katelyn had her good days and bad days, and it was an emotional roller coaster. Her underdeveloped heart and lungs made it difficult to adequately pump blood to her organs or breathe properly, thereby causing her respiratory rate and blood gases to constantly run amok. Protective goggles covered her eyes at all times to protect them from the bright bili lights (fluorescent lights used to treat newborn jaundice) that hung above her incubator. And then there were the more severe, long-term effects to consider – cerebral palsy, vision and hearing loss, brain damage – all plausible outcomes in the event of a sudden intracranial hemorrhage (a.k.a. brain bleed). For hours, amidst the cacophony of beeps and sighs from the machines that monitored our daughter’s progress, Glenn and I remained by Katelyn’s side. By Thanksgiving, everyone at the NICU, including us, thought things were looking up and we quietly celebrated Thanksgiving ourselves in relatively good spirits. Unfortunately, the following Saturday morning, on November 27th, the course of events turned, and our beloved little girl died during heart surgery.

Immediately followingKatelyn's death,I was inconsolable. How could this have happened? First Matthew and then Katelyn. We were supposed to have a family come February 2005! My despair was soon followed by anger – anger at the fact that Glenn and I had to "start over" again. We were now back to square one. After almost two years of trying we had nothing. Nada. Zilch. Back to the RE’s office we go.

We met withthe RE on December 13th. Glenn was worried that it was too soon to try again, but I would not hear anything of it. I needed to get pregnant again. Prior to this appointment, I had arranged to have all my medical records from my [former] OB’s practice transferred to the RE. That morning,as we sat in her office reviewing the records, we were hit with yet another blow. For amidst the pile before us was the dictated November 2nd ultrasound report of the twins – with the quote – “there is evidence of cervix foreshortening and suggestion of funneling". My heart stopped and I felt sick to my stomach. Even the expression on the RE’s face was a mix of disappointment and frustration. When pressed for her opinion in the matter, she admitted that perhaps my OB should have gotten more involved at that time – perhaps put me on bedrest or prescribe tocolytics8 – but refrained to comment any further. My heart broke again, for what felt like the thousandth time. Nothing had been done after that ultrasound and now my childrenwere dead. Again, I became racked with guilt and despair. Furthermore, I now hada physical document that cemented my worst fears: This could have been prevented.

I was out for blood. I dreamed of busting into my OB’s office with an Uzi and blasting her head off Rambo-style. Eye for an eye. Vengeance was mine. As I repeatedly told Glenn, “I want justice for our children.” Equally upset and angry, Glenn understood where I was coming from, however he also viewed the situation as what was done is done. It was too late to change what happened. The outcome was still the same: our children were gone. True, I insisted, but somehow she needed to pay for her mistake. With everything that happened – and everything we now knew – I couldn’t sit there and do nothing. I suggested suing her for medical malpractice. Glenn half-heartedly agreed, but was quick to also point out that in Massachusetts, the statute of limitations to do so was three years, thereby giving us until November 2007 to file. For now, he reasoned with me, why don’t we try and focus all our energies on getting pregnant again instead? Leave it to my husband to be the rational one. For the next few days, I let the idea simmer. Finally, I decided he was right. At this point in time, our immediate goal to have a family was much more important than chasing after her. Not to mention, such a lawsuit could take years to resolve – years my biological clock did not have.

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Christmas 2004 was spent marking the one-month anniversary of Katelyn's death;eight weeks since Matthew had died. Ever since our appointment with the RE, I had become more depressed. It still pained me to no end to know what Glenn and I almost had. To add insult to injury, I was living in a money-pit of a house, still surrounded with drill bits, sawdust and all-around construction filth.

I hated my life. I wanted to die. I wanted to be with our children.

Worried and desperate to help me cope, Glenn suggested that we go see someone together. Someone that could help us work through our grief. A week later, we started seeing Pat, a licensed social worker who specialized in trauma.

By March 2005, we were back to hormone injections. We had deliberately waited until February 26th – the twins calculated due date – had come and gone before trying again. By now, life was just starting to normalize. Both Glenn and I had returned to work and the projects around the house had resumed once more. That April, we went into the hospital for our second IVF cycle. At the RE’s recommendation, we only transferred one embryo. She did not recommend putting in two embryos in the likely event that I become pregnant with twins again, particularly if my cervix was incompetent. While many women have successfully experienced pregnancies with multiples, there was no question in my case that carrying a singleton was safer, would pose less stress on my cervix, and more likely guarantee a full-term pregnancy. To err on the side of caution, once I was pregnant, my RE also recommended that a cerclage9 – similar to a drawstring – be surgically placed around my cervix starting at around ten weeks. The cerclage would remain in place until the fetus reached full-term, or at a minimum, thirty-seven weeks.

To our shock and dismay, two weeks later, the pregnancy test came back negative. We were crushed. It would be another three months before we could try again. Once more, I sank into despair. What if our first IVF had just been beginner’s luck? What if it never works again? What if we don’t ever have children? I anguished. We could adopt, Glenn would console me. Someday somehow, he assured me, we would have a family. Deep down, I knew he was right. Still, I was heartbroken.

Meanwhile, it seemed like every Hollywood celebrity around me was having girl/boy twins. Marcia Gay Harden recently had a set in April 2004; Julia Roberts had hers the end of November that same year. A few months later, People magazine nabbed the first cover photo of Julia with her twins. Like a hawk, I waited in the gym until the girl on the elliptical beside me had finished reading the magazine and put it back on the shelf. Then, when no one was looking, I grabbed it and threw it in the trash. Ditto for the cover story in Good Housekeeping on Joan Lunden and her girl/boy twins – her second set. But perhaps what hit me the hardest were all the news stories about Aleta St. James, the 56-year-old woman who, also with the help of IVF, gave birth to girl/boy twins just three days shy of her 57th birthday. She was now the oldest woman in the Guinness Book of World Records to give birth to twins. It pained me that a woman almost twice my age was able to achieve what I could not. Ironically, her twins were also born on November 9, 2004. “How dare her twins survive and not mine?! It’s NOT fair!” I sobbed to Pat.

I was sick and tired of having to work so hard to get what I wanted in life. God needed to cut me some slack and pick on someone else. I had used up my quota of hard-knocks.

In the weeks that followed, grief from the twins and my obsession to get pregnant continued to consume me. By now it was late spring. Babies born to women with whom I had been pregnant with last May were all about to celebrate their first birthdays. To cope, I binged in the self-help section at Barnes and Noble, poring over every book I could on grief management following the death of a child. Several people close to Glenn
and I had suggested that we join a bereavement support group. But that wasn’t Glenn’s “cup of tea”, and I wasn’t quite ready for something like that – although I did foster well in those types of settings – I was still coping with the fact that I was no longer a part of the Massachusetts Mothers of Twins Association (MMOTA). Last fall, while pregnant with the twins, I had attended three meetings and befriended a small group of women who were also due around the same time as my February 2005 due date. In fact, the day that I gave birth, I had planned on attending another meeting that very evening…

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Summer finally came and with it, another round of hormone injections. Glenn and I continued to see Pat each week for grief counseling. The sessions, combined with the library of books I had amassed in our living room, were beginning to help. My weekly appointments with an acupuncturist who specialized in infertility also seemed to bring on a new sense of calm. Several books I had read had touted the benefits of acupuncture. Further research in the medical literature also sited higher pregnancy rates among patients who received acupuncture in conjunction with their IVF cycles – specifically, before and after embryo transfer – versus patients who received “sham acupuncture” or no treatment. Countering these reports were an equal number of articles that argued for more rigorous studies, implying a high placebo effect10. While both Glenn and I remained partial to Western medicine, we saw no reason not to try. Placebo effect or not, at this point we had nothing to lose. My RE was also on board with the idea, provided that no herbs were involved to avoid contraindication with the hormone injections.

That July 2005, we underwent our third IVF treatment. For the two weeks leading up to the pregnancy test, I did everything in my power to will it to work: I saw the acupuncturist, I meditated, I rented feel-good movies – anything to remain inspired. If there was an ancient Indian fertility dance, I would have done it. Finally, the day came. I sped to the hospital to verify what Glenn and I now believed to be true. Naturally, I had cheated the day before and took a home pregnancy test. The moment the second line appeared – positive – I screamed and opened another test to be sure. Again, it was positive. A nurse called that afternoon with the final confirmation. “Go find yourself a new OB!” she joyfully announced. My expected due date: April 16, 2006.

Two-weeks later I had my first ultrasound with one of two doctors who would now be monitoring me. Given my history, I was now considered “high risk”, thereby requiring the care of a maternal-fetal-medicine (MFM) specialist in addition to my newly assigned OB. I would now have ultrasounds every two to three weeks and my cervical length would be measured at each visit. Like my RE, both doctors came highly recommended and were on faculty at same hospital, where again, Glenn and I wished to deliver. With the exception of my former OB – who also happened to have privileges at that hospital – we remained impressed with the level of care and attention the institution provided. Between my RE, MFM and new OB, we knew we were in competent and compassionate hands.

As planned, at ten weeks I had a cerclage placed. By now it was late September, and Glenn and I had undergone four ultrasounds, all of which were positive. Peanut, as we lovingly called the baby, was growing at the appropriate rate with a strong heartbeat. Everything was normal. Yet despite all of this, we continued to worry. It had not occurred to me until I was pregnant again just how much my outlook had changed. I was no longer a carefree and innocent participant; nor was Glenn. As he best described to close family members – the only ones who knew at the time – “I don’t think we’ll truly be able to relax until we safely pass the 25 week mark…”

Last year we had waited until I was twelve weeks along before officially announcing I was pregnant. This time, despite the insurance of a cerclage, we opted to keep quiet until at least Halloween, when I was sixteen weeks. As the fall progressed, we continued to toil away with the house, reinvigorated once more with the prospect of raising a family. By then, Glenn and I knew the baby’s gender and had decided on a name, but agreed not to reveal it to anyone – not even family – in fear of jinxing anything. What we could divulge was this: depending on the sex of the child, if it was a boy then his initials would be M.A.B., after Matthew Alexander Booma. If it were a girl, it would be K.E.B., after Katelyn Elizabeth Booma.

A small tribute to siblings our child would never get to know.

By November, most of the renovation upstairs was complete. Our nursery would be done with plenty of time to spare. The tone of this year’s holiday season continued to remain upbeat but guarded. I wondered if and when the other shoe would drop. The topic of a lawsuit came up again and was pushed off once more, this time in fear of any stress it may pose of this pregnancy. We could not risk losing another child. We agreed to re-visit the issue after the baby was born.

Christmas 2005 was hosted at our place. A little more than two years after moving into our house, Glenn had finally fulfilled his promise to me to host the Booma holiday gathering at our place, complete with a live Christmas tree. That night, for the first time in a long time, we were fully relaxed and happy. With our close family members gathered around the fireplace, we recounted our blessings: the bulk of the house was done, Peanut was progressing beautifully, and most important of all, we had just passed the dreaded twenty-five week mark. We made it! To further commemorate the occasion, Glenn handed me a small box, instructing me to open it last. Tears welled up when I finally lifted the lid. For inside was a delicate, glass tree ornament in the shape of a peanut…

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On January 16, 2006, I turned thirty-four. That same week, I officially entered my third trimester. I was in the home stretch! By now, Peanut was getting heavier and heavier. The integrity of the cerclage worried me once more. An ultrasound at each prenatal visit with the OB and MFM, however, assured me that everything was fine.

By late February, Peanut was more like a Brazil nut. Each time my OB palpated and measured my belly, he would shake his head, commenting on the baby’s size. If I continue at this rate up to my due date, he said, I just might end up with a ten-pounder! The very thought made me excited but scared, as I hoped for a VBAC11 this next time around.

Around 2 a.m. on April 3, 2006, I went into labor. At NWH, a nurse immediately strapped on two devices: one to measure fetal heart rate; the other to monitor my contractions. Both were nice and steady. I was about two centimeters dilated. A call was put in to my OB. He arrived shortly afterwards and removed my cerclage. Almost instantly, I opened to six centimeters. It completely took him by surprise. “Thank goodness we put that cerclage in!” He exclaimed. A few more hours passed and shortly after 11 am, I was told to push. A half hour later, at 11:38 a.m., our son arrived:

Maxwell Andrew Booma 12
Weight: 8 pounds, 6 ounces
Length: 21 inches

Neither Glenn nor I could believe our eyes when we saw the scale. At almost two weeks early, my OB was right, I would have had a ten-pounder had I gone full-term! Whether it was the effects of the epidural or the high I now felt, I lay in a surprised but relieved daze at the welcome uneventfulness of the entire birth.

The remaining time in the hospital was spent fielding visits and phone calls from family and friends. Word had spread quickly and the support was tremendous. Even my MFM and RE stopped in. At last, we had a child. Two days later, the three of us came home to a small welcome home party. Tied to our mailbox in the front yard, a mylar balloon with the words “It’s a boy!” danced in the wind.

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Whatever action there lacked at Max’s birth was quickly made up during maternity leave. Granted, I had intended to breast-feed – so I knew I would be somewhat busy juggling pumping and feeding – but I was ill-prepared for the sleep deprivation or fatigue that came with it. Nor did I expect to resent my life at times, a life I reminded myself, which I had worked so very hard to achieve. Naturally, the doldrums peaked on those days when Max was utterly inconsolable. I just wanted to wail away with him. As I paced throughout the house in vain trying to comfort him, I, too, would be crying, ashamed at myself for not relishing every moment I had with my child. “After all these years of trying”, I would sob, “I should be loving every moment of this!” The guilt was suffocating, and I started to question myself as a parent. Was I a good Mom? Maybe I wasn’t meant to be a Mom after all? I thought. Luckily, I wasn’t alone in this sentiment. Glenn, too, admitted he was having a hard time adjusting to parenthood. Friends had warned us that the first twelve weeks was all about survival. They weren’t kidding.

Thankfully, after three months, things started to get into a groove. Max began sleeping through the night and life slowly became more manageable. The fog started to lift. Glenn and I grew more and more accustomed to our role of “Mommy” and “Daddy”. Finally, we were witnessing and enjoying all those developmental milestones our friends and baby books had promised: Max’s first smile (12 weeks), first tooth (17 weeks), first experience with solid food (19.5 weeks – rice cereal). And it only got better as he got older.

Yet despite all of this, as the months progressed, the thought of suing my original OB continued to linger. Part of me still wanted to do it; the other part of me always found an excuse to put it off. With Max now in our lives, I worried about the residual impact this might place him and Glenn. Thankfully, Glenn remained supportive of whatever I wanted to do, well aware of the promise I had sworn to Katelyn and Matthew: “When I die”, I would say to him repeatedly, “I want to go to my grave knowing that I did everything I could for them”. If this case went to trial we would get through this, we reasoned. We had been through much worse. My mother-in-law, on the other hand, opposed the idea. “Move on,” she urged. “Go enjoy your happy life. That’s what Matthew and Katelyn would have wanted.” Back and forth the arguments tossed in my head. Ultimately, it was a routine trip to the grocery store that made up my mind.

The pain hit me like a bolt of lightening in the middle of aisle 17. A young mother was pushing a double stroller and had momentarily stepped away to look at an item on the shelf a few feet ahead. With her back turned, I carefully approached the carriage and peered inside. There stood what appeared to be five-month old girl/boy twins – one dressed in pink; the other in blue – both babbling and happily gnawing on their newly discovered toes. The scene completely overtook me and I quickly walked away, partly because I didn’t want the mother to know I was studying her children, but mainly because I was a complete wreck. For a solid fifteen minutes, I cried in my car in the middle of the Stop n’ Shop parking lot. The next week, after several conversations with Glenn’s lawyer friends, copies of my entire medical file were sent to a prominent firm in Boston. Upon its receipt, phone conversations with the lawyer followed. It would take some time, he cautioned, for both he and their medical consultants to thoroughly review all the material before determining for sure, whether there was a case. He would get back to us. It was now near the end of January 2007. We had a little more than nine months before the statute of limitations was up. I was hopeful.

Six weeks later, in mid-March the lawyer finally called back. I was in my cubicle at work when the phone rang. Startled, I picked up the phone. From the heaviness in his voice, I immediately knew the news was not good. We finished exchanging greetings before I told him I would have to call him back. I needed to find an empty conference room where we could talk more privately. Minutes later, and with the blinds closed, I listened as the lawyer reviewed his findings.

Right away he began the conversation by stating how compelling our case was and how deeply sorry he was for our loss. It was, he said with great emotion, stories like ours that truly broke his heart, and as much as he and his colleagues wanted to take on the case, he did not think we had one. The burden for medical malpractice, he explained, was extremely high. In a court of law, physicians hold a lot of power and, sadly, very often the judge will side with the defense. To prove medical negligence, the plaintiff (me) must show that the defendant (OB) owed an accepted standard of care to the plaintiff and that s/he was negligent in providing that accepted standard of care. To demonstrate this, the lawyer had to fulfill two questions: 1) was the accepted standard of care performed inadequate and/or inappropriate to patient care; and 2) prove that medical negligence more than likely was the reason for the outcome: the twins’ deaths. Without a doubt, the lawyer said, both he and the medical consultants agreed they could prove point number one. Something more should have been done at that November 2nd, 2004 ultrasound. The second point, however, would be difficult – if not impossible – to prove. At 24.5 weeks, the twins were so premature that one could not argue with 100 percent certainty that medical negligence was the direct cause of Matthew and Katelyn deaths. As we had personally experienced with Katelyn, infants born that early were afflicted with a multitude of health issues. The burden, therefore, could not be met.

My heart bled again. Tears streamed down my face as the lawyer tried to comfort me. “Contrary to what you may see or perceive on television, the path of medical malpractice is not an easy one,” he began. “For what it’s worth, our firm generally turns away 90% of cases that come to us – for the very reason that I’m turning you down.” He continued. “Of the 10% that do make it, we send them for additional scrutiny through an outside, top-of-the-line medical expert, who further pares it down, often by half. Now we’re down to 5% of what we originally started with. Of that 5%, half will often settle immediately without going to trial. Out of the remaining 2-3% that ultimately does go to trial, over 80% of the time, the judge will rule in favor of the defendant…”

As I listened to the statistics, I could hear the compassion in his voice, his desire to help. It was clear he wanted to, he just couldn’t. Despite all of this, he conceded, he did not want me to leave me empty-handed and suggested that I go get a second opinion just to be sure he had not missed anything. Hopefully, for my sake, he was wrong. He mentioned the names of three more litigators to try and, with my permission, offered to courier my materials to the firm of my choice. I agreed. Two months later, I repeated the same conversation with the other law firm. The burden was too high. Causality for point number two could not be met. They were very, very sorry.

What I could do, they suggested, was report the OB to the Massachusetts Department of Public Health (DPH) and to the medical board. I could also contact the ombudsman at the hospital. Perhaps, if anything, some disciplinary action could be placed against the OB. Defeated, I thanked the lawyers for their time and hung up.

By October 2007, a formal complaint was officially on file with the medical board. By now, Max had graduated into toddlerhood and Glenn and I were enduring the IVF process once again in attempt to provide our son a little brother or sister.

The first time [since Max] the cycle was abruptly canceled due to my body’s poor response to the drugs. Still, I managed to keep my emotions in check and rationalized that I had succeeded getting pregnant before – once with the twins and again with Max – so it could happen again. It had to. Regardless, I reminded myself that at least I had Max.

Three months later in January 2008, and just one week shy of my 36th birthday, we completed our first full IVF cycle. Despite my high hopes, it was a bust. By then, I started to get worried. Fear and doubt had seeped into every pore, and the uncertainty of getting pregnant again gnawed at me. Several weeks later – and virtually déjà vu Hollywood style – People magazine rolled out its cover photo of Jennifer Lopez and Marc Anthony’s girl/boy twins.

It had been almost 3.5 years since Julia’s cover photo, but it still stung. A blatant reminder of what I once had.

In April 2008, approximately a week before our second IVF, we received a letter in the mail from the medical board indicating that a decision had been made: my OB was found not responsible. Hormonal and bloated from the infertility shots, I laid on my kitchen floor like a harpooned whale in a puddle of tears in complete shock and disbelief. Once more, a torrent of emotions ravaged my inner core: anger, frustration, disappointment and sorrow. Despite the bad news, I went forward with the IVF – an emotional attempt to show the rest of the world – particularly my OB – that I was strong. I was NOT going to let this get in my way, I chanted. For two weeks, I managed to uphold this charade until I got the dreaded phone call. I was not pregnant.

This outcome looped like a broken record for three more IVF cycles that July 2008, November 2008 and May 2009. Again, all were negative.

While my OB clearly paid no role in this string of IVF failures, in my irrational world she continued to be The Enemy. If it had not been for Her, my husband and I never would be going through all of this continual pain and heartache.

After the May 2009 cycle, for the next six months, and with the generous support once more of my acupuncturist, friends, family – and lots of meditation CDs – I worked diligently to restore my body and soul. I had been entrenched in a sinister place that I no longer wanted to be a part of. It was time to let those shackles go. In December 2009, I walked into the fertility clinic for my very last – and hopefully successful – IVF procedure.

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My watch alarm goes off, indicating that it is time to start packing up. In an hour, Max will go down for his nap, thereby permitting me an hour or so to peruse the web for adoption agencies. A new process to what has already been a very long and arduous journey. Before we got married, Glenn and I agreed we wanted to have two kids. Hopefully, that wish will eventually come true.

I think back to those dark weeks that followed my conversation with the lawyers, when I again lapsed into a deep period of mourning. For the longest time, I had convinced myself that my twins’ deaths needed to be vindicated in a court of law in order to finally live that “happy life” as my mother-in-law had coined. As time has passed, however, I now realize that that is not necessarily true. There are still other ways to honor my twins’ spirit – ways that are more productive and will also clear my soul.

Grief is an individual process with its own ebb and flow. Through time, I have learned the many different ways people cope. Some meditate; some write songs; some turn to poetry. For me, it was writing this piece. In accordance with Wellesley’s motto "Non ministrare, Sed ministrare" (Not to be served but to serve), I decided to share my story – albeit intensely personal – in hopes that it might comfort other women out there who have undergone infertility and/or suffered loss.

Like any parent, I want my love to be carefree, bountiful and completely focused – because that is what my children rightly deserve – not bittersweet or tinged with pain. Back in my Wellesley days, I never imagined my quest for parenthood to be so difficult. One that would involve:

Two lives lost

Six years of shots

Nine IVF attempts

Closure. I never truly appreciated that concept until now.

This winter 2009 marks the beginning and end of a new chapter in life. This same time six years ago, I embarked on a plane I thought would never land. Now, with new direction, I am in the final leg of an extended and bumpy flight.

Katelyn and Matthew left this world as quickly as they entered it. The twins were unique, special and irreplaceable.

When Max entered our lives, his presence renewed some purpose back in life. Someday, a sibling will join in those footsteps.

I have rediscovered joy…but doing so has not necessarily caused my grief in life to lessen. It has just allowed its shape to change, to better conform to my armor against pain.

Someday, I will tell my children about their older brother and sister.

Someday, I will be able to look at girl/boy twins without sorrow or a lump in my throat – (interestingly, girl/girl or boy/boy twins don’t have the same effect) – and with time, I know this will happen.

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“Hey, look at that big doggie!” Max proclaims, pointing to the golden retriever trotting across the lawn. Again, I’m brought back to the real world.

“Yes, Sweetheart” I respond. “You’re right! That is a pretty big dog!”

We turn into Founders Lot, where a group of students have gathered to wait for the next shuttle bus into Boston. Another wave of nostalgia emanates through. Oh, the memories…

Two girls spot Max and me and make their way over. Without delay, Max flirts with one through a game of peek-a-boo. The other girl and I watch in amusement. Then, she turns to me.

“Is he your first?”13



1 A technique in which egg cells are fertilized by sperm outside a woman’s womb in-vitro. IVF is often performed when other methods of ART have failed. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman’s ovaries and letting sperm fertilize them in a fluid medium. After several days, the fertilized egg (embryo) is then transferred to the patient's uterus with the intent to establish a successful pregnancy
2 A drug classified as a selective estrogen receptor modulator (SERM), used mainly in female infertility.
3 A procedure in which semen is injected directly into a woman’s uterus to improve the chances of conception.
4 A hormone that is measured in the body to indicate the presence or absence of a pregnancy.
5 A subspecialty of pediatric medicine that specializes in the care of newborn infants, especially those that are ill or born premature.
6 A fast-acting sedating drug with a short elimination half-life, therefore useful in for brief periods of time.
7 A bacterium that many people carry without developing infection or illness. In pregnant women, Group B strep (GBS) can be transmitted to newborns at birth. GBS is the most common cause of life-threatening blood infections and meningitis in newborns.
8 Medications used to suppress premature labor and delivery of a newborn.
9 An operative procedure for increasing tissue resistance in a functionally incompetent uterine cervix that usually involve reinforcement, often in the form of sutures near the internal opening
10 Improvement in the condition of a patient that occurs in response to treatment but cannot be considered due to the specific treatment used.
11 An abbreviation for Vaginal Birth After Cesarean.
12 For privacy reasons, the child’s real name was not used for this story
13Shortly after completing this memoir in Jan 2010, I miraculously discovered I was pregnant…naturally…the FIRST time in six years. We found out the day before we were about to send in a 10K non-refundable deposit to start the adoption process with an agency. Our beautiful baby girl arrivedon August 31. 2010. Likeher brother,our daughter's initials are a tribute to her older siblings in heaven.

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