Hello Readers. I decided to start an (irreverent) advice column to answer the many questions that I get on a regular basis. Here is my first attempt.

“What do I do with the negative emotions that I’m experiencing during my infertility journey? I feel like I lose it all of the time, spending my days getting upset, reactive or angry.” —Claire G.

Dear Claire,

I have curly hair. This is both a blessing and the bane of my existence, depending on the day and my mood. If you have curly hair, you know that it can get very big and unruly and hard to hide. I have spent the decade of my 20’s trying various methods of taming it: braids, hiding it under hats, blowing it dry section by section. I have paid inordinate amounts of money on hairstyles that supposedly emphasize my natural curls and have come out of the salon thinking I looked pretty good. That is, until I notice a very similar-looking style on a dog leaving the pet grooming salon. I still spend a silly amount of time brushing it into the perfect ponytail that I see well-groomed, not-sweaty people wear on Instagram, only to go outside in the humidity and realize that the short hairs on my forehead have curled up in less than 5 minutes.

I have a drawer full of products to tame my hair or make it look like someone else’s. These work, sometimes for 5 minutes (if the weather is particularly bad that day) or for a whole day (this is bliss, but only happens one month out of the year or if I stay inside a climate-controlled room where only a few people get to see my hair masterpiece anyway).

So, I gave up trying to manage or tame my hair. Some days, when I really can’t deal with it, using a product or shoving it under a hat is best for me. Most days, though, I allow it to be in its natural state while I continue with my day. In time, I realized that having curly hair is part of me, but it doesn’t capture the essence of me, it’s just something sitting on my head. I can’t let it distract or deter me from going toward my personal or professional goals. My job often involves people seeing me, either via Zoom or giving presentations or teaching in front of a group. Showing up looking like a freshly-groomed poodle is distracting to all of us, at first, but in time we all just ignore my hair and listen to what I have to say.

Why am I telling you this? Because my curly hair represents your big emotions: fear, shame, anger, sadness. Like my curls, these emotions don’t capture the essence of you, they are just words and thoughts that are sitting in your head. Maybe your ‘braid’ consists of tightly-woven emotions, thoughts and feelings that you want to suppress, but then the tightness starts to cause headaches, so you unravel the braid and now you have messy hair and a headache. Maybe your ‘hat’ is the mask that you wear when you want to pretend that you are ok with the helplessness and frustration that often is generated by an infertility cycle.

You probably have a drawer of ‘products’ too because, well, some days you just want a quick way to feel good. Your drawer might contain junk food or wine or Netflix or mindlessly scrolling social media. These ‘products’ make you feel good for 5 minutes or a full day. But they don’t change the fact that you have curly hair.

You need to let your hair down while going through your journey. By this, I mean that you need to realize that you are a deeply-feeling person in a messy and challenging situation. Your feelings aren’t ‘good’ or ‘bad’. They are just part of you. Trying to suppress them is both futile and exhausting, so let them be and use your time and energy on what you need to do to be your best self that day or to accomplish your goals. Like the curly tendrils that escape from my ponytail, you might notice a particularly annoying or persistent emotion, at times, that is trying to get your attention. Notice it. Acknowledge it. Slap some hair gel on it or bobby-pin it if you need to in order to get through your day and realize that that was the best action or strategy for you at the time. Similarly, don’t base your day or self-worth on the fact that you felt angry and acted on it.   

Most of us think that our big emotions can hurt, harm or kill us unless we do something about them, but this isn’t true. In fact, our brain processes emotions very quickly (in about 90 seconds) when we don’t attach or tether them to a story or allow them to play on an endless loop in our heads. It might seem counterintuitive, but let them be. If particularly painful, sit with them, notice what they feel like in your body and how it feels to let them go. Allow them to co-exist with the behaviors and actions that help you feel productive or powerful. It might surprise you to know that there is room for everyone.

So now you know my secret: every time you see me with straight, beautiful hair, just know that the curls are lurking, just waiting to come out. If you see me with crazy, curly hair, then that day I clearly didn’t care to spend the time taming it. But guess what? I can be the best damn me regardless of hair or humidity and you can too.  

Warmly and Wildly,

Monica

A little over a year ago, a professor at a prestigious nursing school reached out to me via my website asking if I’d be interested in writing the infertility chapter in a women’s health nursing textbook. I was flattered and realized it would be an amazing opportunity.

I was also a little nervous.

I weighed the risks and benefits. Writing a chapter in a textbook would be an amazing accomplishment, ensuring that I am up to date with my knowledge of reproductive endocrinology and infertility (REI) while also lending credibility to me as an ‘expert’ in my field. Also, the timing was good. I recently broke my foot and was frustrated that I was unable to run or exercise, so tackling a project like this would be a good distraction.

It would be a big undertaking, though. I’d written articles for journals, blogs, and websites, but the last time I contributed to a book was when I wrote a chapter of questions for a study guide. I was hesitant to re-enter the academic arena, as I became disenchanted with writing for academic publications after enduring an arduous editing process for an article that I wrote on polycystic ovarian syndrome (PCOS).

Did I want to write a whole chapter?

After making a pro-con list and receiving advice from a few trusted friends, I ultimately went with my gut and emailed the editor accepting the assignment.

I met my deadlines and was even ahead of schedule to send in my first draft, but as I prepared to email it, I had a mini panic attack: What if any of my content is out of date? What if someone used my information and the resulting patient care was subpar? Who did I think I was, writing a chapter that was going to be used in prestigious nursing schools?

I spun into a full-blown shame spiral.  This wasn’t the first time I felt like I didn’t earn my spot, or that I was a fraud, a phenomenon that I knew well and later realized was called ‘Imposter Syndrome’.

My first recollection of it was when I was a teenager. I started piano lessons when I was 6, and every year there was a recital. Each student would climb up on a big stage and play his/her memorized piece to the large group of friends and family members assembled there. The recital, like many performances, started with basic pieces and ended with more complex, challenging ones. The message was that the last few performances were worth waiting for. At 16 years old (after 10 years of lessons) I made it to the next-to-last-spot for the recital that year (the ‘closer’ was a 12-year-old prodigy who, I reassured myself, was probably not as well-rounded as me).

When my name was announced, I, in all of my adolescent awkwardness, took my spot at the piano, sweating in an uncomfortable dress and hobbling on high heels that my mom forced me to wear, and sat on the bench. I placed my hands over the keys and my feet over the pedals, took a deep breath and…froze. Froze like in a comedy movie or a nightmare. My thinking brain sounded the alarm: What the hell was I doing? I didn’t belong there! I had been faking it all along! Wait until everyone realizes that I really can’t play.

Somehow, through sheer force of will, I finished, but that moment of panic and self-doubt led to the end of my music lessons and performances. In fact, I didn’t play the piano again until I was well into my 40’s.

The day that the first draft was due brought me back to that stage, and the accomplished adult that I now was regressed to that awkward adolescent girl in the starchy dress and ill-fitting pumps with performance anxiety.

Who did I think I was?

Was my work worth waiting for? How could I allow myself to be vulnerable like this?

Vulnerability as a positive quality is getting a lot of well-deserved traction in the media and academic circles, largely due to the work of Dr. Brene Brown who described it as ‘… not winning or losing; It’s having the courage to show up and be seen when we have no control over the outcome. Vulnerability is not weakness, it’s our greatest measure of courage’.  I personally feel so strongly about the value of vulnerability as a clinical provider that I discuss it in almost all my learning modules and presentations.

I now had an important decision to make: Will I have the courage to practice what I preach?

I heard once that being brave is not accomplished solely in the form grand gestures or sentinel events. It is grown and cultivated in small moments like this, and something in me changed that day. I decided, at that moment, that I was no longer going to be ruled by shame nor defined by my imperfections. I resolved, at that moment, to allow myself to be vulnerable and put my work out there, even if it gets criticized. I came to the conclusion that striving to be perfect no longer serves me.

With this in mind, I hit ‘send’.

Ultimately, the book was published, and a copy was sent to me. I’d be lying if I didn’t admit that I was a little giddy receiving it and seeing my name in print. Although I can’t count the number of hours I spent writing and revising it, I don’t regret the time spent.  I crafted and molded it until it had the right tone. I researched the shit out of it until I was confident that even if I missed something, I did the best that I could. It became something of which I was proud, and I felt justified being the person who was meant to write it.

‘It is impossible to have lived without failing at something, unless you live so cautiously that you might as well have not lived at all-In which case you fail by default.’

J.K. Rowling

I realize that, like the textbook, our lives have chapters. I am done with the one where I doubt myself and my abilities.

Maybe the accomplishment, in this case, is not in writing a chapter, but in closing one.

I was talking to my daughter the other day about why she shouldn’t post a picture on social media of a party that she attended because other kids who weren’t invited might feel sad and excluded seeing the post.
She persisted, but I was resolute. She finally agreed, but stomped away, mumbling how strict and uncool I was (both of which are true).
Why do I feel so strongly about this? Mostly due to working with infertility patients for the last 20 years who are often ‘left out of the party’.

Think about it.

Many women spend their 30’s either pregnant or breastfeeding. Most conversations revolve around topics related to challenges of these, i.e the number of dirty diapers in a day, breasts leaking at inappropriate times, what to do with young kids from 5- 7 pm when it was cold and dark outside and they were bored. Lunches and dinners consist of a discussion of the best products for babies or kids, I know this from personal experience. During this time period, I didn’t post much on social media, but if I did, it would be reflective of snapshots of this life: kids everyday, everywhere. Infertility patients are inundated with conversations and pictures of the family life that they hope to have at a time that they don’t have it yet. Sometimes I would complain about the struggles of having a young family and other times I would laugh about it, like when my daughter told everyone at my son’s baptism that she had lice. Either way, I developed a camaraderie with a group of my ‘mommy friends’ who were in the same life stage. We forged strong bonds as a result of learning how to be moms together. We were all attending the same party. How does a patient who is undergoing infertility treatments assimilate in this world?

In addition to social isolation, infertility patients also experience a lack of control. Consider when someone wants to lose weight. They go online, find exercises and diet tips, get a trainer, join a gym, maybe use some people’s own weight-loss journeys as motivation. Theoretically, if you create a calorie deficit, most likely you will lose some weight. Infertility patients can follow all of the rules, do everything that is asked of them, employ experts, and still may not conceive on a timeline acceptable to them. Consider the loss of control and frustration that ensues. It’s inescapable as reminders of other people’s fertility is present at all times of the day. Imagine being immersed in your own fertility journey and attending a baby shower during lunch at work. Considering going home and receiving an invitation to a baby shower in the mail or electronically. Reflect on relaxing at night while perusing social media and seeing picture after picture of women who seemingly conceive with ease.

My hope is that we are all aware that by living and celebrating our daily family life, we are tacitly, albeit unintentionally, creating an environment that isolates infertility patients and is a reminder of the lack of control they are having in their own lives. Of course, I’m not advocating that you don’t post pictures of your kids or your life, that would be unreasonable and hypocritical of me, as I, myself, do this often. But maybe we can use social media, in this case, as a reminder to be compassionate.

I was reading that a way to instill gratefulness into your life is to silently state something for which you are thankful every time you open a door. I’d love for you to consider that every time you post a picture, maybe you say a little prayer or put a kind thought out to the universe (if you’re not religious) for those who are struggling with infertility or pregnancy loss.

Day 1 of the new website, and am both nervous and excited to start this journey.  I thought my first blog post should be an introduction to me and how Fertile Health, LLC, was conceived.

I, like many others nurses in this field, learned on the job. Even though I graduated with a Master’s in Women’s Health, we had just once class on reproductive endocrinology and it was so complex, that I just learned what I had to in order to do well on the test. Most graduate nurses that I spoke to related the same experience.

After I graduated, I got my first job in the field as a nurse practitioner at Cornell Medical Center in NY, where I interviewed with the medical director, Dr Zev Rosenwaks. At that time, NP’s weren’t commonly working in fertility centers and he wasn’t quite sure what to do with me or what role I would be able to take in a teaching hospital where they had fellows available to do the procedures that he perceived that I wanted to do.  To be honest, I, being new to both the NP role and reproductive endocrinology, didn’t know what to do with me either, but he seemed excited about the prospect of having someone like me, and I was excited to be there, so we compromised: he promised me that if I worked “as a staff nurse at Cornell” for 6 months to really ‘learn the ropes’ that he would find a place for me as an NP there.

He was true to his word. During this 6 months, one of my projects was to convert their teach class, which was on an archaic slide projector, to a PowerPoint presentation. While doing this, I realized that I loved to teach. After that first 6 months, I moved into the role of donor egg coordinator, which I loved, but still felt as though my passion was for teaching. Also, at this time, my friend, Karen Hammond, DNP, asked me to be a speaker at a national conference. I was both flattered and horrified. I had never spoken in front of an audience and wasn’t really sure what I had to say (that anyone would want to hear). But, I diligently worked on my slides for months, asking the fellows to help me revise them, and finally the day of the conference arrived. I was nervous, but gave the presentation and got hooked on presenting, also an important part of teaching.

After a few years, I got married and moved to Atlanta where I continued to work as an RE NP and found that most of practices that I knew of (or where I worked) didn’t have a formal nursing educator or orientation classes equipped with robust lectures, slides and helpful teaching materials. There were many knowledgeable, senior nurses, but they were so busy, that they didn’t have time to set aside to really teach. We all learned “in the trenches” so to speak and I found that some of the nurses didn’t feel confident answering patient questions or teaching classes because of a resulting lack of knowledge. Many didn’t know the latest research because we didn’t have access to an electronic database or journal clubs.

When I moved to Connecticut to work at RMA of CT, I found, in Mark Leondires, MD, a physician who was willing to support me and encouraged me to be a nursing leader by helping write abstracts and editing my presentations. I was lucky. In addition to a lack of formal training programs, most RE nurses, I find, don’t have this kind of mentor or support. I decided then that I wanted to be a nursing leader in my own practice, and for nurses in other practices, by providing them with the knowledge and support needed to accomplish their goals. As a result,  I edit papers, teach people how to do literature searches and pull articles, and help make PowerPoint presentations.

I wanted to go a step further and create learning modules specific to reproductive endocrinology that adhere to the principles of adult learning. One concept is that learning is enhanced by visual aids, instead of using just a bunch of text. I work with a graphic designer and artist to make my own images, ones that, I feel, give learners the visual stimulus they need in order to remember complex processes inherent in RE. Additional research has shown that making participants recall previously learned knowledge, right after the session, can help with learning retention. As a result, my learning modules are followed by either question and answer sessions or case studies in order to reinforce this knowledge and encourage the learners’ interaction and participation.

As a result, Fertile Health, LLC was formed. In my role, I continue to present these modules and lectures for RE practices, like RMA of NJ and Reproductive Biology Associates, in Atlanta, both in-person and remotely. In the next few months, I will be expanding my teaching services,  but also making the modules and/or the slides themselves available for purchase so that RE centers can use them as part of their nurse orientation programs.

I’m excited about this journey and look forward to seeing comments or questions in the months ahead.

Warmly.

Monica