That Time When I Got Zika

Aedes_aegypti Muhammad_Mahdi_Karim

Why traveling to the Dominican Republic was so problematic

Two years ago the Dominican Republic was a hotbed for the mosquito-borne virus Zika. As you may know, Zika is responsible for causing severe birth defects in babies who are exposed to the virus while in their mother’s womb. When I arrived to the Dominican Republic we knew that we would have to put off trying to get pregnant for at least two months starting from the day we left- and that guideline was only if neither of us showed symptoms. If we did have symptoms, and depending on who had them, that period of waiting could increase to 6 months.

However, when I left the USA I also left the Zika hysteria that had consumed the nation behind. In the USA updates and warnings were featured in the news daily, creating the impression that everyone was at risk all of the time. While the risks were real to those who were exposed, the vast majority of Americans never would be. Conversely, there were ongoing outbreaks all over the DR, but very little was communicated to the local population about their status.

Getting a little too “caught up in the moment”

Arriving to the DR (where hardly anyone talked about Zika) and being thrust into medical emergencies and life and death decisions, Zika’s looming threat lifted as well as the concern for waiting to try. Of course it didn’t help that MH’s family members (who had nothing but the purest intentions) would frequently ask when we would start a family, and that EVERYONE had children around us. But when I would voice my concerns about Zika, I wasn’t met with the same ubiquitous anxiety and concern that I had experienced at home.

So as worries faded and the weight MH and I felt from navigating one crisis after another increased, I gradually loosen my stance. Zika seemed like a faraway concern when we had so many other problems to confront on a daily basis. It was a pressure cooker situation, and rather than the stress crack our marriage, it fused us together. And in a city where you can’t do something as simple as go for a run, the best way to release stress was through intimacy. So MH and I figured, “why not just see what happens?”

My first Zika symptoms

After being in the DR for five weeks I decided to head back to the USA for Father’s Day and my father’s birthday. Two days after arriving, I went to the beach, and when I got back I noticed a slight rash on my face and chest. I have lost count of the number of times I have broken out in a rash of some sort after traveling- especially when sun and salt water in the mix. It wasn’t itchy, but my skin did feel sensitive. I wondered if it could be Zika, but at the time I chalked it up to hives from the stress of the trip. That night I took an antihistamine and went to bed.

The next morning I awoke and the rash was all over my body. I felt tired and a little bit of a mental fog, and at this point I knew it was something more. I took a picture of my rash and sent it to MH, who forwarded it to his family. His aunt, who is a doctor, confirmed that it looked like Zika so I started making the calls.

Trying to get tested for Zika

I searched for Zika test locations in New Jersey, but all I could find was a Zika hotline. When I called, I was told the test was only processed at one lab in the state, so I would need a doctor’s referral. The operator recommended that I call a local hospital, so I did. The hospital stated that the only way to be seen was via the emergency room and to be evaluated by the infectious disease doctor on staff. At this point, I was informed that I may or may not be given the test. Since I had already spent a couple of hours researching the tests and their reliability, I knew that the tests available were notorious for both false positives and negatives. Depending on the test used, they also picked up on whether the patient had Dengue or Chikungunya exposure. I decided against spending thousands of dollars to *maybe* be given a test that *might* be accurate. My concern at this point was knowing if I had something else that could be highly contagious.

An hour later I went to a walk-in clinic and was seen by the doctor there. She evaluated me, and ruled out any other infectious disease. I had no fever, the rash was consistent all over my body, and my eyes were clear of any symptoms. She said the only other thing it looked like was Lyme disease, but the timing of my symptoms didn’t align with when I arrived to the USA. I asked if she could give me a prescription for the Zika test, and it became evident that I knew more than she did about the disease and the resources available. I sat on the exam table for several minutes as she researched Zika on her computer. Her diagnosis: yes, it looks like Zika. But to be sure, I should call an infectious disease specialist on the following business day.

The next day I called the infectious disease specialist referral, and was informed that their first available appointment was in two months. Since testing needs to be performed within the first two weeks of the onset of symptoms, it was pointless to make an appointment. I was in disbelief that despite the amount of national attention that was focused on this disease, our healthcare system was so poorly prepared. Literally no one knew what to do with me.

My Zika symptoms: rash, swelling, and aches

I was fortunate that I didn’t have the more severe Zika symptoms, such as a fever or conjunctivitis. However, by this point my fingers began to swell and my hands looked really cartoonish. Then the following day my feet swelled and my joints began to ache. My rash lasted less than a week, but my feet and knees continued to be alarmingly tender when I would walk first thing in the morning; it felt like the tissue was super inflamed. Thankfully after three weeks I felt normal again.

Officially having to wait

Although the medical professionals that I spoke with were fairly confident that I did contract Zika, I was never officially diagnosed. Therefore, I was treated as if I did have Zika in the sense that I would have to wait at least two months to try to get pregnant. I would also have to follow the same guidelines has non-infected people and have to avoid re-exposure for as long as MH and I were trying. Based on research at the time, it was believed once you were infected you developed immunity; however, there was so much that the medical population didn’t know about the virus: Were there different strains? Was it evolving? Were you really immune?

At the time, I assumed once we passed that two month mark I would be pregnant soon after and we wouldn’t have to worry about Zika for some time. I never would have guessed that two years later Zika would be a reason for why we would have to pursue IVF.

Photo Credit: https://en.wikipedia.org/wiki/User:Muhammad_Mahdi_Karim

The Two Year Wait – The Third Year

What was supposed to have been waiting two years to try to start a family gradually slipped into three. After MH and I got married in December of 2014 we had planned on waiting another 6 months or so to start a family of our own. However, around the time that this was supposed to happen we were dealt with several urgent and life altering challenges that had to be addressed before we could move forward. I had shoulder surgery…our home sustained a large amount of water damage from a neighbor above… MH’s parents came to visit, and we could not host them I our home, so we paid for what turned out to be a two month stay in a nearby hotel… add on an emergency room visit for my father-in-law and another shoulder surgery for me, and by the end of 2015 we were physically exhausted and in rough financial shape. My baby fund- which I had diligently nurtured over the past two years and had defended to the very end- had been depleted. We both felt defeated, and in early 2016 our conversations about starting a family were heated and emotional. MH didn’t see how it was possible for the foreseeable future, since he wasn’t willing to raid our retirement fund to provide for a family. I was heartbroken, and for the first time, I questioned whether it would actually ever happen.

Looking back, I wasn’t physically ready to have a child. I was still in weekly physical therapy sessions for both shoulders, and every morning I would have to “warm up” with exercises and stretching to prepare my body for the day. My work, which is 100% on the computer, would leave my arms tingling and numb after typing for a short amount of time. Every day was exhausting, and even as I improved physically, mentally I still felt stuck. My perception of myself was as someone who was incapable and hindered; the pain from my physical injury had tainted my attitude and outlook.

In January of 2016 we got some concerning news from the Dominican Republic about MH’s parents. His father had fallen, and due to his battle with Rheumatoid Arthritis and his heart condition, he was having potentially life-threatening complications. Soon after, MH’s sister contacted us with news about my mother-in-law, who is a breast cancer survivor. She had discovered a lump in her breast and was going in for a scan. MH and I feared and were preparing for the worst.

If you were pregnant, trying to get pregnant, or even thinking about getting pregnant, then you know that January of 2016 was the beginning of Zika hysteria- and for good reason. It was discovered that babies across South America were being born with severe birth defects from women who were infected with the Zika virus during pregnancy. Being that Dominican Republic was one of those areas effected by Zika, we were faced with an additional set of constraints. From the moment that MH returned from the Dominican Republic, we would have to wait 6 months before trying to start a family. It felt like at every turn we were given another reason why our family plans must be deferred.

At the end of February MH and I flew to Miami to meet his mother for a PET scan to determine the severity of her cancer. When we received the results, we were ecstatic to learn that she was only Stage 1, with a possibility of being early Stage 2. With the results in hand, we sat down and talked about next steps. We knew she needed help caring for MH’s father, since the Dominican Republic lacks the same medical support systems that you would find in the US. There are no official home care programs; everything is done by family. And since my mother-in-law would have radiation appointments to keep, she wouldn’t be able to spend hours navigating the gridlock traffic of Santo Domingo taking my father-in-law to doctor’s appointments or picking up medicine from the pharmacy. She asked for MH to come and help, and of course, he said he would.

Coming back to San Diego after the Miami trip was nerve wracking. We knew from experience that the severity of these types of situations weren’t communicated wholly, and that MH’s father would say “I’m fine!” when that was not the truth. I remember crying on the couch while home alone one night, wondering what the other side of this would look like… the amount of debt we would incur… the sacrifices we would make before we could take the next steps in building our future. In a stupid act of desperation I completed one of those Facebook games. You know, the ones where they analyze your profile (e.i. you give them access to your personal information) and return some revelation about what your sprit animal is, or which celebrity is your doppelganger.  This particular “game” was “receive a future postcard from yourself”.  The algorithm must of have had the capability to measure hopelessness, because the words that I received were the words that I most desperately wanted to believe: “The thing you are worrying about so much right now, doesn’t happen. Life is good in the future and you’re such an amazing person. Just remember to be happy!” While I wouldn’t choose those words exactly, it really did feel like an older and wiser version of me was telling my current self not to drive myself into a frenetic state of anxiety over hypotheticals built upon hypotheticals. A calm washed over me, and I still keep a screen shot of that “postcard” on my phone today.

About three weeks later MH went to see his parents in the Dominican Republic, and immediately upon arrival he called to tell me that his father’s condition is worse- much, much, worse- than what had been conveyed. Within two weeks, his father went into intensive care and we were preparing for his demise. Since MH works remotely, he was always able to work from the DR during his visits. However, his company recently adopted a new policy and it was no longer allowed. The only option was for him to take unpaid family leave.

This time of our married life was terrifying. My project was winding down, and there wasn’t additional work in the pipeline. We were prepared to lose one income, but not two. After MH had been away for four weeks, we decided that the only option we had was to rent out our home in San Diego and for me to come join him in the DR for several months. He was in the process of losing one, and potentially two, of his parents. I felt like I was losing my dream of a family and our future. We both wondered to one another whether our marriage would survive this.

I had three weeks to move our personal belongings out of our condo, fix various cosmetic issues in preparation for getting our place ready for rent, wrap up my doctor’s appointments- all while working full time. I wasn’t sleeping, nor was I eating. The non-stop activity, along with the pressure to rent our condo to cover our monthly expenses, left me enervated and fragile. Just two hours before I left for the airport I finished cleaning, putting our belongings in storage, and packing the 5 months worth of clothes and personal effects that I would need while out of the country. When my husband picked me up at the airport in Santo Domingo he immediately acknowledged my drawn face and the weight I had lost. He filled me in on everything that had transpired that he couldn’t discuss on the phone on the drive to his favorite bakery, where he ordered me the largest slice of chocolate cake I have ever seen. Despite all of the worrying over the last six weeks I felt with certainty that now that we were together, everything would be fine. And in terms of our union, thankfully I was right.

The Two Year Wait – The Second Year

The first weeks

The weeks after our wedding were blissful. We traveled from Dominican Republic to Miami where we had a mini honeymoon. We also officially tied the knot in the Miami Beach Art Deco styled court house. MH and I people watched, jogged through the boardwalks and parks, and ate amazing Peruvian ceviche. During this time, however, I had a nagging shoulder pain. It had started the year before during an improperly taught barre class.  It seemed like the physical therapy sessions I had in the month prior to getting married didn’t fix the problem.

Shoulder surgeries

As an avid (AKA obsessed) surfer, I found this pain and weakness in my shoulder to be life altering. Surfing was my outlet, my escape, my reset button, and my spiritual source. Without the daily routine of waking at dawn and surfing before work I felt lost, and really cranky. The constant and increasing pain wasn’t helping my mood, either.

 

The story of my shoulder surgeries, the pain and misdiagnosis leading up to them, and the life altering results are a novel of their own. All I can say is that I was in intense physical pain for a long time.  Three years later I am still adjusting to my “new normal”. My first shoulder surgery was on my right shoulder in May of 2015. When I had I stopped physical therapy prior to my first surgery, my left shoulder destabilized, so six months later I had surgery on my left shoulder. I had stretched out both my capsules from the repeated overhead motion of surfing, improper muscle use, and just poor genetic luck.

 

Surgery fixed the problem (it was treated as a labral or SLAP tear for those who are wondering), but the nerve pain, which was exacerbated by any type of computer work, was physically and emotionally exhausting. For an entire year I was in a constant state of irritation and borderline depression. The last thing I could think about was having children; I literally did not have the ability to lift or hold them.

The unexpected

To make matters worse, our small condo received thousands of dollars of water damage just prior to my first surgery. A neighbor who was renovating his condo above was testing a pipe that was apparently unconnected, and the result was our kitchen and bathroom being flooded. We unexpectedly had to move out for several days.  The contractor hired by the insurance company was terrible.  It took 5 months for the work to be completed. What this meant, though, was that when MH’s parents came to visit us from the Dominican Republic they couldn’t stay with us. Their several week stay turned into two months in a nearby hotel, during which MH’s father went to the emergency room due to an Rheumatoid Arthritis crisis. He hadn’t taken enough medicine with him before he left, and his body was on the verge of shutting down.

An unfortunate event

Shortly after my in-laws returned back to the Dominican Republic, I got news that my cousin had tragically passed away. Going home to attend the service and spend time with my cousins and family was a healing experience.  However, for many months I was hurt, shaken, and angered by his death. The voids that had been created by what “could” and “should” be from every other challenge that I had experienced so far that year paled in comparison to the vacuum created by actually losing someone you love.

 

By the end of 2015 my baby fund was drained and I felt like I was at my breaking point. MH’s and my union was tested in ways I could not have imagined during our first year of marriage, and I could not have anticipated that the hurdles would keep coming in the months ahead.  Starting a family seemed so far away.

The Two Year Wait – The First Year

When MH and I started dating things moved pretty quickly. We met in March, by July we were living together part-time, and in September we took the leap and rented a place of our own. While I thoroughly enjoyed being courted by such a romantic (and cherished my independence), I wanted to gauge whether or not our relationship had marriage potential. After all, I was 30 and I knew I wanted to have children, so I felt like I didn’t have time to waste. We rented a charming cottage with a patio and a garden (that I would subsequently kill) in the eclectic and eccentric beach community of Ocean Beach. By January we decided we liked each other enough to buy a condo together, and begun the conversation about starting a family. Of course, once we started paying our monthly mortgage payments our financial obligations became tangible, and the concept of reducing our income by half for any amount of time was no longer in the abstract. The weight of these new commitments was acutely felt by MH, so we agreed to wait.

 

Originally we had agreed to wait two years. Two years, I had thought, would give me enough time to shore up some savings AND enough time to “massage” the idea for MH a little more. I had hoped that given some time to acclimate to our new life together his desire to start a family sooner rather than later would return.

 

The first year living together was a blur of travel to Hawaii, Seattle, Vancouver, Whistler, Channel Islands, Coachella, New Jersey, New York, and Las Vegas. We also managed to accomplish some serious remodeling in our condo in between being on the road and our demanding work schedules. At times it was overwhelming, but we had a blast.

During July of 2014, however, our pace came to a screeching halt. While I was in New Jersey visiting my family I received a flurry of texts from MH’s sister and her husband, who were unsuccessfully trying to contact MH.

 

His father was going into emergency surgery, I was told, and he may not make it. He needed to fly home to the Dominican Republic as soon as he could. I flew back to San Diego a couple hours later, and the next morning we flew to the Dominican Republic to be with his family. Upon our arrival learned that his father had a massive heart attack, and although he was expected to recover, he came very close to passing away. We had been waiting until we were actively traying to start a family to get married, but this experience had a sobering effect. We couldn’t take for granted that our parents would be at our wedding, let alone be grandparents to our children one day, so on at a beach bar in Cabarete we decided to move up our timeline.

 

The day after Christmas we had the loveliest, most intimate and beautiful wedding I could have ever imagined at sunset on the beach of Playa Coson, in Las Terrenas. My parents, sister, and brother attended, along with MH’s immediate family. As someone who did not grow up dreaming about my wedding day, it unexpectedly had felt like the happiest and most important day of my life. And on that day looking ahead, I was anticipating growing our family in the upcoming months.

From there, however, life did not go as planned. At all.

Deciding When

Decided when to start a family became such an exciting prospect. It was something that was debated, carefully considered, and rationally decided. Of course, those conversations came after our blissful honey moon phase of “Yeah, we have only known each other for a couple of months, but let’s see what happens!”

Having children was a part of our conversation since our very first date. We later concurred that getting pregnant within the first six months of knowing each other was unwise, even though we frequently tempted fate by being less than careful. It was as if our hearts and minds were dueling the way a rebellious teenager and strict parent would.  Occasionally we would let our hearts get revenge for minds for unilaterally deciding what was in our best interest.

Having it happen within the next six months wasn’t ideal, either. Ten months into our relationship we decided to purchase a home together. Right before we signed the papers I thought I was pregnant, and I was beside myself. How would my husband really feel? Would he still want to buy a home if a baby was on the way? Housing in California is so expensive… are we ready to live off of a single income? Will he be ready? I thought the timing was terrible, and was dreading telling him. However, when I did, he was excited. “Why would that change anything?” he asked. Several days later we were disappointed (but a little relieved) when my menstrual cycle began.

At the 15 month mark we were living in our new home, and I announced that I didn’t want to wait any longer. I was 31, and armed with statistics, I made the case for why we should start trying now if we want to have more than one child. MH*, however, had a different take. Sometime within the last several months he had transformed from dreamer into provider. “We have a mortgage.” “We are not ready to lose an income given that we have no family within 2300 miles to help.” “We haven’t started a college fund yet.” All logical and understandable objections (minus the college fund, IMO), however it didn’t sway how I felt. I wanted to become a mother. He suggested that we start trying in two years, and I acquiesced- and the countdown started.

*MH (My Husband) asked that his name not be used publicly… he is a private creature 😉

To Have or Not to Have: Switching from Ambivalence to Certainty

I never thought much about having children when I was young. I am an animal lover, so in middle school my idea of a “perfect” family was a husband and a home full of creatures. In my high school and college years I had serious boyfriends, and overtime the concept of having children became more amenable and acceptable- partly due to my innate maternal desire, and partly due to the subconscious pressure to conform to social norms.

I mostly dated men who wanted to have children. My high school boyfriend wanted to become a father someday, and we picked out nicknames for future children. Even as college approached, the reality of us actually getting married and settling down was abstract and so far off; I never had to reconcile my true ambivalence towards the path we were on. We broke up before there was any proposal.

My college boyfriend adored babies, and his paternal drive was so strong it created insecurity as I questioned the veracity of my own ember of desire to be a mother. We, too, broke up before there was any proposal.

Like many of my peers, I spent my early to mid-twenties preoccupied with launching a career and finding a life partner. In my mid-twenties I appreciated being with someone who shared my point of view on most things in life. He, however, was adamantly against becoming a father. I loved the freedom that I had, and was really turned off by how small some parents’ worlds had become once they crossed that chasm.  From outside appearances, it looked like they were living a rat race- unsatisfied, exhausted, and just wanting for the kids to grow up and move out. I was genuinely happy for the people I knew who were having babies- It just didn’t feel like it was for me. Still,

Looking back, I can now see that the subtle pangs of wanting to experience motherhood were there. It was the lifestyle that wasn’t for me. Giving up my identity to become “Mom” seemed like the inevitable outcome of becoming pregnant; of course now, I have so many women in my life who model how to integrate children into their lives without giving up who they are. I have even seen motherhood complete them in a way they couldn’t have imagined.

By the time I reached my late twenties my heart was saying “bring it on”, but my mind hadn’t quiet caught up. I remember dating someone who was a couple of years younger than I was, and when we spoke about the desire to have children his outlook surprised me. This free-spirited man proclaimed that “having children is a part of the human experience”. When he looked at his brother, who had a child out of wedlock (to which his family was not very pleased), he didn’t see a man making poor choices. He looked at it as a miracle of life. After hearing his take, I knew where I landed in the decision of to have or not to have.

When I was 29 I realized that I was not going to meet the person I was meant to marry living where I was. If I felt that my home state didn’t offer the life that I wanted, I couldn’t expect to meet my life partner there either. The following January I moved across the country to San Diego, and two months later I met my husband. And I knew within months that I wanted a life- and a family- with him. So then, it became a question of when.