Image by Pinakeen Bhatt
Most students that top their class in the Kenya National Primary and Secondary exams want to become Neurosurgeons. All because of Ben Carson and his gifted hands. Not Susan Karanja. She didn’t wait for an exam mark to determine what she wanted to be. An advertisement did that for her.
In the early 90s when she was 10 years old, she spotted an image of a man on a billboard whose body resembled a straight line. His skin was stretched tight over his protruding bones making him look shiny and stiff. When she looked into his eyes, it felt like she was peering into a bottomless pit. And the words written in bold red caps next to his image might be the reason why; ‘AIDS KILLS. There is still no cure.’ She turned to her mom who was driving and said, “Mom, I want to help that man.” And the seed was sown.
11 years later, she sat at a cafeteria in Medical School with some friends. They had just joined the course and were trading tales on the experience of cutting through dead skin. “By the way guys, my aunt has been sending me to pass greetings to one of our classmates. But I don’t know who he is and I haven’t managed to trace him..” Susan was cut short when a handsome gentleman joined them at their table nodding at a few familiar faces. She ignored him and went on, “Anyway the guy’s name is Eric Njenga….”
“Yo! That’s my cousin. What has he done?” the handsome lad interrupted again. She turned to face him and never turned away.
This is how Susan met Nick.
They didn’t start dating immediately. It took almost another three years of a cat and mouse chase for them to be together. And then, they were inseparable; all the way to the same internship centre. “I knew Nick was the one, the second year into our relationship. He was so easy to talk to. When I was with him, I took center stage — everything else falling away. He got under my skin so much I only had to look a certain way and he would pick on what emotion I was feeling. And he was dependable.” Nick must have felt the same way because soon after internship, he proposed. And then, she left.
Not him, the country. For further studies in South Africa. “I totally loved surgery in undergrad but was also fascinated by the nervous system,” so she married the two and decided to specialise in Neurosurgery.
When she left, their ecosystem shifted. The people around them did not understand how one gets engaged and then leaves the country to pursue a five year course. “There were loud whispers but we had already discussed it and set a wedding date for approximately a year later.”
Nick planned the wedding by himself. She was only able to fly in briefly to pick vendors and then left everything else to him. The next time she appeared was two weeks to the wedding. “I was so amazed at how he pulled it off. Everything went according to how I had envisioned it.” You see? Dependable.
Two weeks after the wedding, she was off again; with nothing but love and a commitment to communicate every day for the next four years. “We agreed that if at any point the distance became too much, one of us would move to join the other but we were hell bent to make it work.” Nick by now was also in a Residency program in ENT so they only saw each other two to three times a year. And those were times of absolute bliss. A prolonged honeymoon. And when they parted, there would be a countdown to when they would see each other again. “We didn’t feel married. In fact when I came to Kenya to see him, I would feel like a visitor in my own home.”
In December 2015, Susan completed her Mmed and came back home — a Neurosurgeon. The honeymoon period was done. “I remember the aunties saying, ‘aaah it’s great you are back. Now you can get down to doing what is expected. Have children.’” But Susan wanted to settle first. She needed to get a job and they needed to really really be married.
“Going shopping with Nick was an ordeal. He is a great cook and had gotten used to preparing meals for himself when I was away. He had brands he liked and I had my favourite brands too. He wanted to have chapati on Wednesday; I wanted chapati on Thursday.” There was no way they were bringing children into that muddle. So they spent a year figuring out whether rice tasted better with ndengu or with mince meat. Or why one person couldn’t sleep in longer or the other stay up later. It was a year of unlearning and relearning.
When 2017 came by, and they were riding the same wave, they made the decision to officially try for a child. Because it is not rocket science, they saw the gynecologist for the usual preliminary check up and off they went. Days, turned into weeks, then into months and then 2017 had been swallowed up just like that. No baby.
Out of concern, they went in for a review that prompted several tests. One of which showed she had one blocked tube. “I promptly put on my scholarly hat and read up on the statistics of conception with one fallopian tube. The numbers looked promising. Nothing too alarming.” But then why hadn’t she conceived? Yet she had been home for two years? So the gynecologist referred them to a fertility specialist.
“If one tube is blocked, the other is most likely blocked as well,” the fertility expert said matter of factly, “so I would advocate for IVF.”
When Susan heard the words IVF she was stunned. They tried to negotiate for a less invasive method but he impressed upon them the need to go straight to it and they complied. “I was not sure how we would get the time or finances needed. I just wanted to go home and cry.”
Still, they went ahead with it. On the day they were set to start treatment, the sun was up bright and early; set in the backdrop of a royal blue sky. They skipped breakfast because they had to be at the clinic by 7am. Early as it was, rays of sun pierced through the windows of the clinic — almost like a message of hope. The place looked chique with tasteful furniture. “But even a decision as simple as where to sit felt like solving a puzzle. I saw a coffee dispenser and wanted to get a cup but then I wondered, what if coffee was not allowed? So I passed.” They sat there quietly, waiting their turn, exchanging a word or two, “because it honestly felt like talking in church.”
The cycle of IVF was both physically and emotionally draining for them. From the daily clinic visits, to the daily injections, to dealing with the effects of the hormones. “I gained weight, I was constantly bloated, had hot flushes, mood swings, fatigue and bruising at injection sites.” And despite all that she had to wear a mask of normalcy, go to work and operate on people’s brains.
The day they harvested the eggs was definitely her worst. “It felt like knives twisting in my lower abdomen and worse still I was on OR duty that day at work.” It killed Nick to watch her go through such pain. “Unfortunately we are all alone in our bodies and we only told a handful of people about what we were going through.” Infertility is a lonely journey.
After implantation they were to wait two weeks to do the pregnancy test. 14 days of heightened anxiety. On the 10th day however, her period came. And an arrow of pure red panic shot through her. “I knew the cycle had failed.” Saturated with grief, they went to the clinic for review where the nurse insisted on giving her a progesterone shot. “Why bother?” Susan asked, her will broken and bent, “I know it hasn’t worked.”
And she was right, because as soon as they left the clinic, she did a pregnancy test that turned negative. “I remember sitting in my bathroom, my eyes drilling holes into the concrete. I knew the statistics, knew that the first cycle could fail, but the reality lodged into my throat and refused to go down.”
On day 14, they still had to go for their scheduled appointment. Another pregnancy test was done and when the psychologist told them it was negative, she said, “We already knew.”
They went home disheartened. Later, the clinic called to remind them that they still had embryos and should go for a second cycle. They waited a while, summoned their guts and went back. This time she was ambivalent. And the cycle was less dramatic than the last. “After implantation, I took time to rest then resumed work. Followed the diet, did everything I could. But in a sad twist of fate, my period came again before we could even get to do the pregnancy test.”
Second cycle — failed.
This time Susan sunk into an abyss of hell. Her pain became a living thing, it was in business and it was thriving. She pushed Nick away and buried herself in her work. He on the other hand was irritable. She would look into his eyes and know that he too had been crying. “I did not want to hang around people with children or attend functions that involved children. I avoided pregnant women.” Anytime Nick tried to draw her in, she would smile sadly at him, her eyes as flat as the eyes in a painting. “All I wanted to do was cry and talk about children. The same children I did not want to see.” There are days she would wake up fine; then she would remember; and it would feel as if someone had pushed her off a building and she was in free fall. “I folded so much into myself until one day Nick said, “I think you may be going into depression.”
“I think you may be right.” She had gotten to a point where she started to question her faith, science, and the connection between the two.
He guided her to a chair and they sat down and he said, “I don’t like what this is doing to you. To us. On our wedding day I said my vows to you. Not to you and our children. You. The whole point is I married you and I am ok if we never have children but I can’t lose you.” And he said it to her again and again until she began to feel the concussion in her chest clear.
“And we decided right there we were not going for another cycle. It was too harrowing for my mental health and our marriage.” You can’t put a dollar sign on peace of mind. They were not willing to pay the price.
So they took a step back to just enjoy themselves. August came, which was her birthday month and she spent the month on a chocolate and wine diet. Just relaxing, reconnecting with Nick and taking time to rebuild her mental health. On the day of her birthday after giving her presents, he asked her, “What are you praying for this year?”
“Well, I would still want a baby but I am no longer obsessing over it.” So they prayed and moved on.
Susan got busy in the next month with work, planning a baby shower for her sis in law and trying out a new diet. “That month I had such bad PMS. I was bloated, had constant headaches and was so out of it.” Nick said, “We should go on holiday. Take a break. It will do us good.” But a close friend and her sister were concerned about how ill she was becoming. The symptoms just kept getting worse. Out of the blue her friend suggested, “do a pregnancy test.”
“Huh? We were told I can’t conceive naturally. It’s just PMS.” The truth is she didn’t want to go on the rollercoaster of emotions she had, the last two times she peed on a stick. It needed a great amount of mental energy.
“Just do it.” her friend who was also a medic insisted.
So she peed on a stick. And then closed her eyes.
When she got the nerve to look, her thoughts were a soundless scream.
“I called Nick to where I was and I was whispering — as if my voice would change the results if I spoke loudly. When I showed it to him, his reaction was just as I expected. We cried for hours.” The test was positive!
The joy was so palpable but was soon replaced by anxiety. “What if I lose the pregnancy?”
They went to the gynecologist who turned the anxiety up a notch when she said, “we need to do a scan to rule out an ectopic pregnancy.”
And it was harrowing.
During the scan, the sonographer kept focusing on a certain area in her pelvis saying, “I see a mass here. And cysts in the ovary here.” And with each word her face crumpled. Everything he said pointed to an ectopic pregnancy. Susan couldn’t wait for him to finish so she could go and cry outside.
Later, the gynecologists pointed out that indeed there was an adnexal mass that looked like an ectopic pregnancy co-existing with a single live intrauterine pregnancy. A rare finding which occurred in 1 in 30,000 pregnancies.
They were asked to repeat the scan some time later which they did when she was 9 weeks. It showed nothing but a healthy intrauterine fetus.
“Still, fear took residence in my heart. I would pray so much until it got to a point I felt my prayers were not enough.” They went to their parents and gave them the news. Both mothers started crying. “I told them I needed back up prayers to help me get through the pregnancy.”
Eventually the pregnancy got to term. It was uneventful. No complications. They got a baby boy.
When they decided to try for a second baby, they knew it would take a year or two for the process. “This time let’s not panic even if it takes time sawa?”
“Sawa.” They agreed.
They conceived the first month they started trying. And recently got a baby boy.
Dr Nick Ngugi and Dr. Susan Karanja Ngugi are now parents of two boys.
As Narrated by Dr Susan Karanja Ngugi
IN VITRO FERTILIZATION (IVF) — Is a treatment for infertility in which a woman’s eggs are fertilized by sperm outside the human body.
One or more of the fertilized eggs (embryos) are then transferred into the woman’s uterus, where it is hoped they will implant and produce a pregnancy.
WHO SHOULD CONSIDER IN VITRO FERTILIZATION? — IVF is usually considered by couples who have:
●Absent or blocked fallopian tubes. ●Severe male factor infertility (sperm counts or sperm motility is low) ●Advanced reproductive age, ●All other causes of infertility (eg, endometriosis, ovulation disorders, unexplained infertility), if treatment with other therapies is not effective. ●An inherited genetic disease that they wish to avoid passing on to their child ●Ovarian failure, although donor eggs would be required in this case.
Although IVF has a high rate of success in helping couples to become pregnant, it has some disadvantages as well, including: high costs, potential risks from fertility medications and invasive procedures used, as well as an increased rate of multiple gestation (ie, twins or triplets).
Women who are considering IVF should discuss the risks, benefits, and alternatives with their healthcare provider and partner before treatment begins. In most cases, several cycles of a less expensive and less invasive infertility treatment are recommended before considering IVF.