When in Doubt, Send Food

I used to think it was a little silly, the way so many of us (particularly women, it seems) respond to major events in other people’s lives, whether happy or sad, by sending food. As if a pound cake will mend a heart broken by an unexpected death. As if a pan of turkey tetrazzini will make the “witching hour” less crazy-making for a mom caring for a newborn, a toddler, and a preschooler.

Then I got cancer. And for two months, people fed me and my family. For two months, people—close friends as well as acquaintances, even a few people I’d never actually met before—showed up at my door with chili and casseroles and salads and cake. And it suddenly made sense, this impulse to feed people who are going through something life-altering. For those eight weeks, what to make for dinner was not on my daily agenda. For eight weeks, I got a daily reminder that my family was not dealing with my cancer by ourselves.

For almost a year, I’ve been waiting for an opportunity to do for someone else what everyone did for me. I got it this week, when a good friend lost her father to complications of multiple sclerosis mere days before giving birth to her third baby, and first son. When I heard about her dad, I told her I’d be bringing a meal, because either she would be grieving and hugely pregnant, or grieving and caring for a newborn. Neither of which would be particularly easy.

So I made this meal.

And I was reminded again of why food played such a big role in Jesus’s life and ministry (the loaves and fishes, the last supper, the disciples eating fish on the beach with the resurrected Christ). The best lesson I learned from my cancer was that feeding people really is the most tangible and humble way we have to love one another.

The second-best lesson was that, for some reason, when people make meals for someone who is sick, grieving, or caring for a new baby, they deem pasta with red sauce to be the perfect thing. Lasagna and baked ziti and meatballs in sauce. I adore pasta with red sauce, and make this recipe at least once a month, eating it every day for lunch and dinner until I’ve swabbed the last bit from the bottom of my pasta bowl with a crust of bread. But after two months of eating what other people provided, I was red-sauced out. One day, near the end of my treatment, my husband found me in the kitchen, head in hands and on the brink of tears. I had gone into the freezer to see what of my cancer bounty was left that I could serve for dinner, and all I found was a big tupperware container of red sauce. I simply could not bear to eat any more red sauce. It sounds petty and ungrateful, and it was, though perhaps the fact that I was going through cancer treatment during the snowiest New England winter in memory could be considered mitigating factors. My husband, bless him, shooed me out of the kitchen, did something with the red sauce (I never asked what), and ordered take-out for dinner. I don’t remember what we ate that night, only that it didn’t involve red sauce.

So for my friend’s meal this week, I avoided red sauce and instead made pan-fried chicken and creamy potato casserole, which is so full of fatty dairy products that it is really only appropriate for a nursing mother. All those extra calories will go straight to work fattening up the baby.

Besides providing more fat and calories than are really necessary, what will this meal really do for my friend? Not much. She’ll still miss her dad. She’ll still have hundreds of days in which she’ll be scrambling to put food on the table at the time of day when she and her kids are most tired and needy. My little meal won’t change any of that. Just as all the meals I got last winter didn’t change the fact that every day for weeks, I trudged to the hospital, where I lay with chest fully exposed as a room full of radiology techs (male and female…all young and good-looking, of course) prepared to zap my misshapen, surgery-scarred breast with killing radiation. Just as the meals my friend Rachel brought to her longtime friend Mr. S. in his final days in a nursing home didn’t take away his severe pain or keep him from dying last week as he held his wife’s hand.

No, these meals we offer to one another during life’s most demanding moments don’t really change anything, don’t really do anything. Except give people a visible, substantial, simple reminder that they are not alone. Which is a pretty big thing after all.

Fertility Treatment Might Cause Ovarian Cancer (But Your Doctor is Unlikely to Tell You That)

A large, comprehensive study in the Netherlands indicates that ovarian stimulation (artificially inducing a woman’s ovaries to produce multiple eggs) increases the risk of ovarian cancer two-fold.

Previous studies examining a possible link between fertility treatment and increased cancer risk were inconclusive for various reasons, including the studies being too small.  (That has not stopped some advocates who are uniformly opposed to assisted reproduction from using junk science to make unsubstantiated claims about the link between fertility drugs and cancer, as in the independent film Eggsploitation, which I reviewed here and here.)

So with this new and impressive data, will fertility clinics start publicizing the risks of ovarian stimulation to their IVF patients and egg donors? It’s unlikely. As Gina Marento observed in a Biopolitical Times editorial about the Netherlands study, even the American Society of Reproductive Medicine (ASRM), which advertises lay education as one of its goals, has done a shoddy job of providing good information about the health risks associated with fertility treatments. Marento also observed that college students she talked to were well-aware of the financial benefits of egg donation, but had no idea that there might be health risks involved.

Reproductive technology operates in an emotion- and money-driven environment that makes deliberate, informed decision-making particularly hard for patients. This environment has flourished for a number of reasons:

Reproductive technology serves patients who are highly motivated to undergo treatment, and to do so as quickly as possible. When patients arrive at a fertility clinic, it’s often after months or years of trying to get pregnant. Couples who marry relatively late but hope to have children seek fertility treatment much sooner than that. In most cases, patients feel pressured to try whatever technologies are available, as soon as possible, to maximize their chances of conceiving. As for egg donors, the tens of thousands of dollars that donors from top colleges can get provides an incentive that’s hard to resist if you are a young women buoyed by the idea of paying off college loans in exchange for a few weeks of injections and a minor surgical procedure.

Reproductive medicine is a lucrative specialty that operates under a consumer-driven market model. If patients feel pressured to become pregnant as quickly as possible using whatever means necessary, then their physicians feel similar pressure to treat as many patients as they can, as successfully as possible, in order to attract additional patients. Clinics use their pregnancy rates as advertising fodder to attract patients, many of whom are paying tens of thousands of dollars out of pocket. Both doctors and patients admit that they are reluctant to adopt certain safety measures (such as transferring fewer fertilized eggs to a woman’s uterus to lower the chance of risky multiple pregnancies) because of the perception that doing so will lower the chances of success. In such an environment, it’s hard to imagine that a stringent discussion of potential cancer risks will take place.

Due to a lack of regulatory oversight and the pace of technological innovations, reproductive technology progresses faster than our ability to consider its ethical, emotional, financial, and medical consequences. American fertility medicine (unlike in many European countries) is not regulated. The ASRM issues guidelines (such as on the number of fertilized eggs to transfer, or how much egg donors should be paid), but the guidelines are voluntary and regularly ignored. Fertility clinics are essentially able to offer whatever services they can, to whomever is able and willing to pay. Occasionally, a public outcry will stem the tide of innovation, such as when a California clinic known for pushing ethical boundaries offered preimplantation genetic diagnosis (PGD) for parents wishing to select their child’s eye and hair color, then backtracked in the face of opposition. But such reversals are uncommon. The lack of oversight allows the industry to essentially move forward via human experimentation; we learn about what works, what doesn’t work, and the risks involved not through laboratory findings and extensive trials, but by examining data from people who have undergone treatment. Journalist Liza Mundy, in her book Everything Conceivable, points out the irony of this development, which she traces to the 1995 Dickey-Wicker amendment that forbids government money from being used in any research involving human embryos. In trying to protect nascent human life, advocates of this amendment also effectively removed the fertility industry from any potential for government oversight. As a result, the unregulated fertility industry regularly manipulates embryos in all sorts of ways, and employs more and more complex treatments on patients without anyone (clinicians or patients) understanding all of the risks involved. So much for protecting human life.

The main thing that I advocate for is a more deliberate and informed process for patients (including egg donors) to make decisions about whether or not to use reproductive technology. This process should involve: 1) fertility clinics building in time and resources for patients to receive information, counseling, and support regarding the health, emotional, financial, and ethical dimensions of treatment; and 2) a concerted effort among those in a position to provide that information, counseling, and support (clinicians, counselors, pastors, etc.) to become better informed about those dimensions of treatment.

This new data concerning cancer risk is just one of the many important aspects of fertility treatment that should be a routine part of the introduction to clinical services and patient decision-making…but isn’t.