Monday, March 28, 2011

The IVF story continues: Direct Debit or Bust

After my first round of blood tests and ultrasound on the third day of my menstrual cycle, and after being told by the hospital that I owed money to my health fund, I called the clinic at 1pm to find out the results. They told me to come in five days time for another blood test and ultrasound. Meanwhile I had to deal with the money I owed Maccabi or the hospital would not treat me.

Apparently my visit to a GP and my initial meeting at the IVF clinic, my only two visits to a doctor in ten years, had woken a sleeping monster. As the visits occurred in two different quarters of the year, I owed six shekels per visit. Add to that a few hidden administrative costs and I owed them all of 24 shekels (about $8 at the time). The woman behind the desk at the Maccabi offices (the wonderful Mika) suggested I open a horat kevah. This is merely 'direct debit' in English, but in Hebrew it conjures up horror stories of money disappearing from your bank account at the whim of the recipient, never to be returned or explained.

This is probably left over from the days when they didn't read every water, gas or electric meter every month. Rather they would estimate the bill and make compensations at the end of the year. The result of this was either a massive bill that was very hard to afford in one month, or else you found that you'd overpaid by hundreds  of shekels. The house would be credited - sometimes just before you were moving apartments or leaving the country. In effect, you had given a free loan to the electric/gas/water company which may have sent you into overdraft for which you paid interest for months. Many people in those days would do anything to avoid the dreaded horat kevah.

In 2005 there was a sense that things were better. At least there was a network of telephones and computers so you didn't have to personally visit every office and literally accompany your paperwork through the system. I signed all the relevent documents and Mika told me she would send it to my bank and the whole thing would be set up. I asked if I could pay the 24 shekels meanwhile, as I was sitting there and as I had the money. No, Mika assured me that it would be included in the horat kevah.

I went back to the IVF clinic five days later. This time I knew to sign my name on the ultrasound list before doing anything else. It was 7.30am and I didn't want to be there all morning, again. I got my notes from the nurse and rushed down to get them stamped at the reception before heading up to haematology for my blood test. I remembered to swipe my Maccabi card through the machine and get my printout. It was full of little notices in Hebrew which I didn't bother to read.

"It says here that you owe some money," said the receptionist.
"No, I dealt with it. I went to Maccabi and set up a horat kevah."
"I'm sorry, it says here that you owe 24 shekels. This is your second notice so we can't allow the treatment without authorization from Maccabi."

I called Maccabi. it was 8am and the recorded message said that the office opens at 8.30. I called the emergency 24-hour number in Tel Aviv. They told me to call the Jerusalem office at 8.30. So I waited - for a change, and then called Mika at 8.30. She got on her computer and confirmed that there had been a problem with the horat kevah. The bank hadn't accepted it. I called the bank. "What do you mean the problem was with us? Maccabi didn't send the right forms."

I called Mika back and promised to come in and sort it out, but could she please fax an authorization through to Hadassah Hospital as I needed my treatment today and they only did the blood tests until 9.30am. I really tried not to cry and I sort of managed it. Whether it was the tremble in my voice I don't know, but Mika faxed the OK and I was through to the next level.

Up two floors, take a nunmber, give blood - only two tries this time before striking gold, put the vile of blood in the heart-shaped plastic basket in the lab, back to IVF. They were way past my name for the ultrasounds but I was first on the list so I went straight in. "Call at 1pm for instructions." And I was back at the bus stop at 9am. I'd halved my time. This was getting easier.

Back at Maccabi Mika discovered that although a new horat keva can be set up via a request from the health fund, a previously cancelled arrangement required me to go to the bank and reactivate it. I was puzzled. Had I ever had a horat kevah for Maccabi? Then I remembered. We had all had one about 15 years previously, before health care became a pay-as-you-earn tax. When that came into effect we all rushed to the bank to cancel our horat kevah so that we didn't end up paying twice.

One trip to the bank and it was sorted. And my phone call at 1pm told me that I had to do the whole morning routine at the clinic again in two days time.

Thursday, March 24, 2011

Being in the right place at the wrong time

Last weekend we spent Shabbat (Saturday) with friends on Kibbutz Alumim. This is a kibbutz in the Northern Negev, 5km from the border with Gaza. Since the beginning of the second intifada in 2000, they have had numerous red alerts as missiles have been launched at the towns, kibbutzim and villages of that region. The siren goes off, a loud voice announces "RED ALERT! RED ALERT!" and you are supposed to run to the nearest shelter. Some people do (mostly those with young children) and others don't bother. Whatever your reaction, it is terrifying. There have been injuries and even fatalities on other settlements but, thankfully, so far the main living area of Kibbutz Alumim has been spared a direct hit.

Before I became pregnant with DD, I was one of the more laid back customers when the missiles came. As my hosts didn't panic, neither did I and we waited where we happened to be. Then, one time I was alone in my room when the red alert sounded, and I was pregnant. And I was not in one of the new houses with reinforced rooms (a.k.a. bomb shelters). Did I say I was pregnant? It obviously made all the difference. I froze as I considered my options. Stand in the door-frame? No, that was for earthquakes. Run to my friends' house? No, too far. In the end, after almost a minute of thinking about it, I dived under the bed.

Now what? How long should I stay there? Until I heard the explosion? No, you don't always hear anything. Was there an "all clear!"? I couldn't remember. I didn't have my watch on so I counted to 300 - five minutes was surely enough time, and then came out. Even then, I wasn't sure that it was all over.

When I returned to my friends' house, they laughed at me. Apparently you only have 15 seconds to reach cover before the missile hits. By the time I was under the bed it was all over.

Last Shabbat there was no red alert but, when DD and I went for a long walk around the kibbutz after breakfast, there was a lot of helicopter activity. We own helicopters, they don't, so I wasn't alarmed. However, I knew that something must have happened for us to be so active on a Shabbat morning. DD didn't like it. "Noise!" she said, "no like it!" Then we heard the blasts as the helicopters fired and struck - I didn't know what. "Don't worry darling," I said, "it's just bombs."

Later we found out that there had been a number (reports varied between 30 and 50) of rockets fired over the border. The rockets are short distance missiles and so fast that there is no time for any warning. Subsequently two terrorists were killed close to the border, about 3km from where we were. In the light of the attack last week when a family was stabbed to death in their beds, it felt close.

Then yesterday there was a bomb in Jerusalem that injured 30 people, some of them on the #74 bus. This is a bus that I sometimes take as its route goes through my neighbourhood.

So my Thank you Thursday this week is to God, the Universe, my Guardian Angels, Fairy Godmother, whatever it was... that kept me and DD in the right places at the wrong times. I don't know what I did (or didn't do) to deserve it but please know that I am continually thankful for your protection. And thank you for protecting my friends too.

Tuesday, March 22, 2011

Purim Epilogue or Too Much Chocolate

Purim is just one long sugar rush in costume (or not in costume if you've been following our celebrations). For those of you who don't partake, one of the traditions is to give small gifts of food to friends and family. Sweets and baked goods are most common, especially among children.

DD and I finally arrived home yesterday evening exhausted, high from the sugar, and covered in chocolate. As we stepped into the house DD could not believe her eyes: two more small bars of chocolate sitting on the coffee table. She made a run for them and had them clasped to her chest before I could say, "Wicked Haman" So instead I said, "No DD. You're not having those now. You'll be sick!"

She ran into the kitchen and stupidly cornered herself into the kitchen cabinets. I advanced with stern face. "You've already had lots of chocolate today. You can have those tomorrow. Not now." I swear I saw a lightbulb go on in her head. She quickly darted forward and thrust one of the chocolate bars into my hand. "Mummy!" she exclaimed (intonation up at the end of mummy to show there was more to follow). Then she put the other bar up to her heart, "DD!" - intonation down implying satisfactory end to conflict.

She looked so pleased with herself that I almost let her have the chocolate. It was an ingenius solution to share the bounty with the dictator. However, she would have been sick and enough is enough. I took the chocolate from her and, to the sound of loud howling from the kitchen floor, put both bars away for tomorrow. I've probably put her off diplomacy for life.

Friday, March 18, 2011

Tears Before the Parade - Mine

On Sunday (or Monday if you live in a city that was once a walled city, like Jerusalem - don't ask) we celebrate Purim. As with many Jewish celebrations, the old joke applies - How do you define a Jewish holiday? They tried to kill  us, we won, let's eat. However, each festival does have it's own special flavour and Purim is our answer to Mardi Gras and Carnivale. As today is the last day of school before the holiday, all the children dress up in costume and have a fun-day instead of lessons.

DD has a fantastic costume - a present from our friend S. It is a ladybird complete with dress, antennae, gloves and wings. DD was so excited. She knows all about ladybirds because her nursery is called The Ladybird Nursery. We hung the costume on the wardrobe and, for the past week, she has shown it to everyone who came into the house.

This morning I put on her red tights and black shoes and took out the Ladybird dress. DD screamed. There was no way she was wearing that dress! I cut off the black netting under-skirt because I thought it may have frightened her to put this over her head. I bribed her with chocolate for breakfast. She put on the dress, ate the chocolate and then screamed, frantically trying to rip the dress off, until I relented and took it off for her. I was almost as upset as she was, whilst still being able to appreciate the irony: You will have a good time whether you like it or not!

"OK, at least let's go to the party in something nice," I said. She didn't want any of her dresses. Eventually I pulled out a new top with flowers on it and she happily put it on. I got out the trousers. "NO TOUSIES!" The law according to DD says you don't wear trousers with tights. I suggested we took off the tights and put on socks. "NO!" So I stuffed the costume and the trousers into her bag and we left the house with DD wearing red tights, a T-shirt, and her pink jacket on top. Almost ridiculous enough to look like a bizarre costume. I was fully dressed.

On the way to nursery we passed Darth Vedar, clowns, fairies, boys in drag, Disney characters, super heroes, and even a banana. Every time we we saw a little girl with wings I pointed them out to DD. She was happy to appreciate the beauty of wearing wings, from a distance. The parents sympathised with me. "I'm more upset than she is," I said. And I could feel the tears welling up in my eyes. Oh, for God's sake Rachel, it's a costume and she's two years old! Shut up inner voice, I know it's just a costume.

At the nursery I left DD and her costume. "I'm glad we're not the only ones," said Y's father as he dropped Y off. I felt a bit better. "Don't worry," said the assistant nursery teacher, "at the end of the day I'll have a photo of her in her costume."
"Or not," I replied.
"Or not." We both smiled.

P.S. Pictures on Sunday.

Thursday, March 17, 2011

#ThTh: Three cheers for the driver!

When we were children and went on a coach trip to anywhere - and back, as we approached the pick-up point where the parents would be waiting, we would all sing: Three cheers for the driver, the driver, the driver. Three cheers for the driver who drove us today!

I felt like singing that this evening when my friend Binny, who drove me to, and later home from, an evening with friends, offered to drive my babysitter home. This saved me paying for a taxi for her. When you barely earn enough to reach the end of the month, this is a big deal. Thank you Binny, I really appreciate it.

Monday, March 14, 2011

The Nestle Boycott - Truth or Hysteria?

I sat down this morning to do some work - real for-money work not fun blog-work - on my computer. As usual I couldn't resist a quick peak to see how many more millions had viewed my blog (2 since last night - 2 people not 2 million) and if there was anything new and exciting on my blog roll. I was drawn to Notes from Home's Friday Club on ethics and activism. I didn't contribute because I didn't have anything to say. I keep a meat-free kitchen but eat meat when I'm out so I'm not a moral vegetarian, or even a vegetarian. I try not to buy processed foods, but sometimes do and, anyway, that's more health and budgetary issues than ethics. Apart from that I will not be rude to anyone online. That sounds more holy than it is - anything in writing will always come back to haunt you. So there you have it, many half-baked ideals but not much action.

I've been hearing a lot about the Nestle boycott over the past few weeks - since I started blogging and social networking in mid-January. I vaguely remembered something about providing free baby formula to poor women in developing countries and then stopping the free supply as soon as their breastmilk has dried up. But this was a long time ago. Was it still happening? Are there any other issues? There must be something going on for all my extremely sensible and right-on blogging friends to be so up-in-arms about it. So I set out (sat down) to click my way through some research.

It was suprisingly difficult to find out the basic arguments against Nestle in an up to date document. I found, through the Friday Club (see above), Heather at Note from Lapland who wrote the most comprehensive overview of the situation, published on August 5th 2010. I figured that if any big changes had occured in the last seven months we would have been informed. Like me, Heather was reluctant to take on board everything she read on Wikipedia without looking into it first. Luckily for me, Heather did a lot of research. As I said before, I am not much of an activist and I am certainly no journalist, so why re-invent the wheel when Heather put so much work into it. Please read what she has to say.

The things that shocked and/or surprised me:

1. It's not just the issue of the breastmilk drying up and, therefore forcing these poor women to buy formula which they can't afford so the babies starve. There is also the fact that they often don't have clean water to mix with the formula so the babies get sick. They often water down the amount of formula to make it last longer so that the babies are under nourished. And, of course, there is the issue of breast is usually best when possible.

2. Living in Israel, much of our food comes from Osem. Nestle owns 50.1% of Osem. Who knew? Well probably loads of people, but not me. DD loves Bamba, we only recently finished with a bottle of Maturna (formula) at bedtime, Bissli (which we can do without), soup stock, pasta.... Luckily all these have alternatives. And it is far more healthy and economical to make my own potato cakes than buy Tivall/Tivol vegetarian products (Yes - Tivol too).

3. I colour my hair with a dye from Garnier. Yep - owned by Nestle. Amongst the Hebrew, Arabic and Russian printed on the box, is a logo that promises the box comes from well-managed forests and other controlled sources. Is this what they mean when they say that Nestle also does good stuff? Also beware of L'Oreal (another personal favourite for make-up) - because it's just not worth it.

So how far do I go? I will stop buying the Nescafe and the Bamba, Garnier and L'Oreal. And I will try to stear clear of the other products on the list of Nestle products (scroll down to the bottom of the page). Do I go so far as to put the Nestle-free-zone badge up on my website? I didn't notice it on any of the other blog sites about boycotting Nestle. I will if you will -  let me know. Which means that I'm still a bit apprehensive about making a big noise over something I've heard about through the grapevine as it were. On the other hand, as there is so much negative publicity around Nestle and they say they have cleaned up their act - why don't they do the public relations campaign and prove it beyond doubt? They are not lacking in funds for this so I tend to think that if they won't it's because they can't.

P.S. I shared Heather's Note from Lapland article on my Facebook wall. A friend commented that he had visited the Nestle HQ in Switzerland on a 6th form trip. His impression was that they have admitted to many wrong-doings in the past and are now doing quite a lot towards fair trade. Unfortunately, I think this strategy is what Nestle are relying on.

Tuesday, March 8, 2011

An Only Child

Sometimes I find myself choosing the name I would give to DD's little sister - because it would be another girl. That's the great thing about fantasies, you can control every detail. And if I'm honest, I have actually spent (read: wasted) a lot of time on this. Then I jolt myself back into the real world and fantasize about something that has more chance of happening - like winning millions in the lottery for which I never buy a ticket.

Why are these little sister thoughts intruding on my usually fulfilled, satisfied, content and extremely grateful mummy-psyche? My theory is that DD is two-years old. Two years is when families start bringing home the next child. Among DD's friends at nursery, two have just had new additions to their families and another is due in a couple of weeks (all girls coincidentally - but not helpfully).

They say that when God wants to punish you he answers your prayers. It's true that I always loved children and wanted to have a big family. But that was then, when I was also going to be an executive wife and possibly a famous actress. In real life I grew up into a different person. What does the person I am now, in my current life, really want?

Around the time of DD's birthday I had a dream that someone handed me the next baby - as if they automatically arrive at two-year intervals. In my dream I panicked: Oh no! I can't go through all that again. It was wonderful the first time, but now I'm ready to move on to the next stage. I'm looking forward to spending time with my little girl. I don't want another baby now!

It's not just my age (late 40s). As a single mother I feel I can create a good life for two of us. I would cope with three - because I am a coper, but who wants to cope? I want DD and I to have a good life that we can enjoy rather than it passing by in a whirl of logistics, piles of ironing and unmade beds. If I were independently wealthy it might be another story, but I'm not. Therefore, through necessity, I am a totally hands-on mother. This includes hands-on cleaning, shopping, laundry, childcare, bringing home the bacon [except no bacon], and looking after myself. I only have two hands.

Then there is the issue of my health. Thank God, my health is good (pht, pht, pht). However, pregnancy at my age was a strain even two years ago. It would not be fair on DD to risk my health going through another  pregnancy. As much as I would love to give her a sister, a healthy mother is more important for her at this stage in her life.

There is a saying in Hebrew: lo haser li klum. Literally it means: I'm not missing anything. However, the connotation is: There is nothing missing in my life. When I look at DD and play with her, talk with her and do her hair, cuddle with her and share a private joke, I honestly think to myself lo haser li klum.

I hope that DD will continue to build deep relationships with her cousins and our close friends. I promise her a home that will always be open to her friends for play-dates, sleep-overs, weekends, holidays. And I will try to give her an exciting and fun-filled life with a relaxed mummy who has all the time in the world for her (and the housework, earning a salary, etc...).

P.S. For those of you who are wondering, a pregnancy at my age would entail donated eggs. This would not be an issue for me if I were set on having another child. And if he were a boy I would not send him back ;).

Thursday, March 3, 2011

#ThTh: The Cycle of Giving

I can honestly say that I have never bought any clothes for DD. Well 99.9% honestly - I bought a set of vests for the winter in Sainsburys when we were in London, and I have bought packets of socks. I've chosen clothes for her, bought with gift vouchers and when returning gifts that were unsuitable, but that's it. Really. And she is two and a few months old. So this week my Thank you Thursday is an appreciation for the mummies who participate in the cycle of giving.

The cycle of giving is not just passing on your old clothes and equipment to the next baby. I have a friend who regularly turns out her own wardrobe and goes shopping for new clothes. When she gives me the clothes she no longer wears, I call this passing on her old clothes. I'm very grateful for them - they are always good quality and my friend has exquisite taste, but it's not the same as the cycle of giving and receiving baby clothes, toys, seats, buggies, etc... for growing babies, with growing needs for items that are essential for a few months and then become obsolete.

When S had her baby in the winter, there were many joys she could finally experience first hand - some expected and some wonderful surprises. One day she said to me, "You don't know how good it feels that I can now be a part of this cycle of giving." S has always been a very generous friend to me and DD, she loves buying gifts. However, this giving comes with a different, a special, kind of love. I can't even explain why and I know that all our gifts came with much love. And everyone has their own style of participation.

After her first baby, a daughter, A held out for another girl for years. All the girl stuff - dresses and anything pink - were lovingly stored. By the time DD was born, A's daughter had a number of brothers and we got four storage boxes full of clothes. They came with instructions to pass on what we can't use. That's the perfect way to receive things by the way - who remembers where everything came from in order to give it back? What a burden to have to keep things in pristine condition, and try explaining to your two-year-old that she can't have chocolate in that dress because it has to go back to so and so. Thank you A.

M is a hoarder and, just as I think the time has come for me to go shopping for new clothes for DD, she turns up with bags of clothes and toys that her daughters have recently grown out of. As an official hoarder, she is also an infamous willing recipient for other people's outgrowns. I get these as well. Thank you M.

R comes from a huge family and gave us 33 onesies when  DD was born, most of them never worn. A sister and about six sisters-in-law with older children means that her storeroom is like an outlet of Mothercare. Thank you R.

Thank you to the mothers of my students for regular supplies as your children grow up and out of everything.

Receiving is great, but the giving part is just as exciting. I have classified three different methods of giving. For the things in perfect condition that my friends could use, I put away to give as gifts when an appropriate occasion arises. By the time S's lttle O arrived, I had two boxes of 'stuff' for her, including a free-standing baby-bath/changer, a baby rocker seat, a cot mobile...none of which had been bought. I kept these things for her before she was even pregnant. A few boxes in the corner of my study for a year or so was a small price to pay for helping to keep the hope alive for S.

Things in good condition but for which we have no use - outgrown, not our taste, wrong season, etc... go to the gemach at the well-baby clinic. Gemach is a Yiddish word for store, I think. Anyway, it is a place where those in need can go and find whatever they want. The nurses take items with them when they go on house calls to the poorer communities.

Things that are definitely 'past it' go to the bins. Not in the bins, but folded nicely and hung in a bag on the side of the bins. Believe me, there are people who take from the bins. Anyone who needs to take from the bins is welcome to have, mend, and enjoy. The bins method has actually evolved into quite an effective recycling point. The bins at the corner of our street are like a regular second-hand shop. The bins outside the school are almost a second-hand bookshop - you see the smartest people going for a rummage there.

Epilogue: N phoned and asked me if I wanted a couple of potties that her twins had used. I told her, thank you very much but for 20 shekels I think I'd rather buy DD a new potty. The next day I saw the potties by the bins as I popped round the corner to the shops. On my return, about 15 minutes later, they had gone. However, thank you N for the raincoat you gave DD for next year.

Tuesday, March 1, 2011

Entering the IVF System or On the Fifth Day I Waited

I had done all the blood tests and acertained that I didn't have HIV, hepatitus C, diabetes, and various other conditions. My donated sperm was waiting for me at the Sperm Bank and my FSH count was high (basically the number of eggs you have left). I was very optimistic. I'd opted for IUI without any intervention. This is, to put it simply, the proverbial turkey-baster method. They take the sperm and squirt it into the uterus with a catheter. No drugs. No procedures. I just had to come to the IVF department five days into my cycle for a blood test and an ultrasound. In this way they would start monitering my ovulation. "And start taking 5mg of folic acid a day." No problem.

On the fifth day I set the alarm at 6am. I got up and showered (I was going for an ultrasound) and was out of the house by 6.45. On the bus at 6.55 and at Hadassah Hospital at 7.25. Smug? You bet! The unit opens at 7.30 and N had told me to get there early or I'd be waiting around all morning. By 7.30 the queue was already starting to form.

I waited, with my notes from the blood tests and my letter from the Sperm Bank, to see the nurse. She told me that I had to get my papers stamped at reception and then go up to the fourth floor where I would give a blood sample in haematology.

I went to reception and took a number. I waited. At last my number came up and I went to the vacant window. "Where's your printout from your health fund?" asked the clerk.
"What printout?"
"You have to swipe your card through the machine on the wall and you will get a printout."

I went to swipe but I had lost my place. I took another number and waited again. Meanwhile, I read the printout. It seemed that I owed Maccabi (my health fund) some money. This was confirmed when I reached the window again. "You have to go to Maccabi and sort it out. If it comes up again we won't be able to give you treatment."

My notes were stamped and I went to haematology. There was a corridor full of women ahead of me. I took a number and waited, again.

When it was my turn I went in and sat down. I'm not nervous of needles but apparently I have very narrow veins. I once tried to donate blood and they couldn't find any. They eventually took it out through the back of my hand. Not pleasant. I explained about my narrow veins. The nurse wasn't interested. She took blood from a hundred people a day and she certainly didn't need my help in finding it.

The needle touched my inner elbow and I winced in anticipation. Then I felt it go in. Actually it didn't hurt at all. "Interesting," said the nurse, "you do have narrow veins. I'll try again over here." She tried again. "Maybe give me your other arm?" This time it worked. I took my blood and returned to IVF.

"What have you got there?" asked the nurse.
"My blood sample. Where should I put it?"
"You were supposed to take it to the lab in haematology."

I went back upstairs. And it's not just back upstairs. It's downstairs, along two corridors, across the reception area, past the coffee kiosks, up two flights of stairs, and along another corridor. I deposited my test-tube of blood and returned along the corridor, down the stairs (two flights), past the coffee kiosks, through reception, along the corridors (two) and up the stairs.

I was ready for the ultrasound. I retrieved my file from the nurses' station and added my name to the list. I was number 33 and she was only just seeing number 15! I looked around the waiting room. There were only six women waiting. Where were the other 12?

Slowly other women began arriving. I recognised some of them from the queue in haematology. They sat down without signing up for ultrasound. One of them was called in and her name was crossed off the list. She was number 16 for ultrasound and yet she'd been after me for the blood test. The penny dropped. What an idiot I was. Of course you sign up as soon as you arrive - before you get your notes stamped, before you go to haematology, and you're already on the list!

I went in for my ultrasound at 10.45am. It took five minutes. "Call us at 1pm and we'll tell you what to do," said the nurse when I returned my file.

At 11am I was waiting for the bus to go to work. 3 1/2 hours. Three years later and after about a hundred of these early morning sessions, I'd got it down to half an hour. One time I was back at the bus stop by 7.50am. But back in February 2005, I wasn't planning to become a regular fixture in IVF. I was planning to be pregnant in about two weeks time.