Entry 2

Monday’s my day off. I work four days a week, a schedule that is far more conducive to caring for my own medical condition than full-time is because the fact is I have to see a lot of doctors, double that when I am pregnant. I’m in my third trimester now, in the middle of an Atlanta summer, so I could be more comfortable, but overall I’m feeling well.

Today I saw my high-risk obstetrician, Marcy Mann. I love Marcy because she is totally unfazed by any of the complications of my pregnancy.

During my last pregnancy and for this one I’ve stopped my interferon shots. There’s not a whole lot of research on what interferon does during pregnancy. Like most medications, it’s pregnancy category C, meaning in some lab animals it seems to have some deleterious effects, but it’s never been tested in humans. It’s not possible, of course, to test a medication on pregnant humans. The only way we know for sure that drugs are bad is when women taking them get pregnant and then have deformed babies, as was the case with thalidomide. There are some women who have taken interferon through their pregnancies. In fact, it’s used to treat a certain rare condition that can develop during pregnancy called essential thrombocythemia, when the woman makes too many platelets. This condition can cause strokes and heart attacks, and so if it gets that bad, it’s worth the risk to take a category C drug. There are no reports of deformed fetuses in these rare cases, but then there are only a handful of cases. To me, it wasn’t worth the risk. Interferon has a myriad of effects on the immune system and the developing blood cells, and if one day something terrible develops in one of my children, I would not want to wonder if my taking interferon was possibly to blame. Marcy is OK with this decision, but she thinks it would be all right for me to be on interferon, too.

No one knows the long-term effects of these months off interferon for me. The short-term effect is rather unpleasant, but bearable. I’m covered in warts. I first got warts when I was 15 years old, and the dermatologist I saw did not tell me that I could spread them by shaving my legs. Warts are caused by a viral infection, and I am uniquely susceptible to certain viruses, including that one. I spread the warts by shaving, and now I have warts covering my legs, my armpits and my bikini line. They’re not very attractive. I’m embarrassed by them, and despite the 95-degree weather here in Atlanta, I won’t wear shorts or go to the swimming pool all summer. These are relatively minor sacrifices, I know. The more disturbing implication is that I also have cervical warts, and these put me at risk for cervical cancer. Next week, I get to see my gynecological oncologist for a colposcopy, when he will look inside my vagina at my cervix with a microscope and try to assess how abnormal the cells are. Marcy says if it looks bad, I can go back on the interferon. That usually melts the warts away—it doesn’t cure them, but they flatten out and sort of go to sleep. My fear is that if they trip into full blown cancer, interferon won’t be enough.

At least I got to see the baby. Marcy is monitoring the growth of the fetus, so the silver lining to having a high-risk pregnancy is that you get lots of ultrasounds. Also, because of the warts on my cervix, I’ve had many surgical procedures so my cervix is shorter than normal which puts me at risk for pre-term labor. Marcy is keeping an eye on this, too. The ultrasound technician squirts warm jelly on my abdomen, and I look up at the TV screen overhead and see my baby. She’s looking close to human now; in fact, today she was sucking her thumb. The tech measures the length of the leg bone, the amount of amniotic fluid, the width of the head, and the circumference of the abdomen. The baby seems to be developing beautifully. Marcy comes in and looks at the flickering black-and-white image. “Oh, she’s cute,” she says. I can’t say she’s cute yet; the ultrasound picks up bone structure, so she looks skeletal, with hollow eyes and sunken cheeks, but at least all the parts appear to be in order, and that’s reassuring. I smile. I am looking at my baby.