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“There are other options.”
That sentence, spoken in the calm and careful tone of someone professionally trained to deliver emotional IEDs with the minimum possible shrapnel, felt equal parts clinical and deeply personal. Dr. Stephanie Roemer, Steph to her friends and colleagues, was ruthlessly efficient in her compassion and one of the only people on earth who could wield a speculum and a sense of humor with equal skill. Today, however, the humor was subdued.
Those were not the four words Poppy Davies wanted to hear coming into this appointment. Over the past eighteen months she’d created a diagnostic bingo card for her reproductive health. It was dark, but it was the only way she knew how to get through the difficult journey. And now, after countless appointments and five doctors, every box was filled in: “run more tests,” “asymptomatic endometriosis,” “scar tissue,” “it’s not your fault,” “reduced egg quality,” “blocked fallopian tubes," “implantation problems,” and finally, “there are other options,” bingo.
She wished her friend would just say the unsayable and punch her in the gut with the truth instead of tiptoeing around it in soft, indirect phrases. It wasn’t Steph’s fault, Poppy ambushed her. After discovering through the grapevine, aka the admin in charge of scheduling, that they both happened to have a free hour since the MRI Poppy had been scheduled to administer was cancelled and Steph’s 11 a.m. was moved to 2 p.m., Poppy showed up at Steph’s office door, medical records in virtual hand—she’d emailed them—asking for a fifth opinion.
One of the perks of working at a hospital was first dibs on last-minute cancellations. Which is how she found herself lying on her back with a device that resembled an oversized electric toothbrush dipped in KY Jelly shoved up her hoo-ha, exploring her uterus. To be fair, the transvaginal ultrasound wand was technically state of the art, but from Poppy’s vantage point it was simply a cold, foreign object that exposed her damage.
Above her, she stared at off-white ceiling tiles made popular in the mid-90s that could have been hung in any clinical setting. These, however, were adorned with glow-in-the-dark stars arranged in random constellations. They’d probably been placed there by a nurse trying to create a more whimsical environment, or maybe by some hopeful administrator who thought they’d distract patients from their own existential dread. Poppy focused on them now. It was either that or look at the monitor, which showed a gloomy landscape that was supposed to contain her hopes and dreams but instead looked like a haunted moon.
If she focused hard enough, she could almost believe she was floating in space, drifting between the cracks in the galaxy, instead of lying in a backless gown with her feet in cold, steel stirrups as her future was rationed out in percentages and probabilities. Before coming up to the fourth floor, she’d forbidden herself from crying, but apparently her tear ducts hadn’t gotten the memo. A hot, prickly pressure gathered behindher eyes. She could feel it would only take the gentlest nudge, a hand on her shoulder, a look of pity, or a sympathetic,“Oh sweetie,” to break the dam.
What made this all so ridiculous was that sheshouldhave been prepared. Sheshouldhave been used to it by now. This wasn’t her second, third, or even her fourth opinion, it was her fifth. Before Steph, she’d heard four different physicians tell her four different variations of the same theme: “I’m sorry, but…” There was, theoretically, some comfort in consensus, except when the consensus was that your body’s warranty had expired before you could actually use it.
Ultimately, she only had herself to blame for being an incurable optimist. Poppy was the person who always packed for a trip that could get cancelled, who never deleted her exes’ numbers, and who wholeheartedly believed in the possibility of a lottery win despite never having bought a ticket. Okay, that one was just delusional. She was the girl who read her horoscopes, plural, for the week ahead and circled the best one. She couldn’t help but think that if she just kept showing up to these appointments, eventually, the universe would blink and the answer would be different.
But the universe did not blink. It just stared at her, unflinching.
There was something deeply wrong with a world in which everyone else was conceiving babies by accident, sometimes on the same couch as leftover Taco Bell wrappers—which is precisely what happened the night her sister Phoebe and husband Duane got busy and got pregnant with her five-month-old niece Bristol—while Poppy had to schedule each indignity in advance and pay a specialist’s consult fee for the privilege to find out if even thepossibilityof that happening was in the cards for her.
She was so lost in this private inventory of grief that she was startled when Steph withdrew the wand and set it aside with a gentle thunk.
“You can sit up,” Steph instructed.
The snap of rubber gloves reverberated in the sterile examination room, the sound ricocheting off the steel fixtures, the tile, and even the clear acrylic tissue box mounted to the wall. Poppy, who’d been trying to breathe through her mouth to avoid the smell of disinfectant and latex, gingerly sat up on the table. The vinyl crinkled loudly beneath her, making her feel more exposed than the paper gown already had.
She tugged at the hem of her blue modesty gown, trying to maintain some dignity as the exam table paper stuck to the back of her thighs. Thanks to an ample backside whose cheeks acted like the hungry-hungry hippo to all underwear and disposable lining, she’d developed a technique to avoid the dreaded paper wedgie, hold the edge with one hand, shift a cheek, slide and sweep at the same time. If she timed it right, she achieved a smooth landing with no crepe lining between her cheeks. She succeeded, resettling herself as the clank of the metal trash can announced the end of her friend’s examination and the finality of the diagnosis that had been trailing her through four different doctors.
Steph rolled her wheeled stool across the small space, a practiced ballet of medical grace, and swiveled to face the monitor, affixed to a pivoting mechanical arm. The screen’s blue glow illuminated her profile, which was shadowed and tense. For a moment, Poppy wondered what Steph saw on the screen that made her jaw clench like that.
She cleared her throat, and Poppy braced herself. Steph had a repertoire of “doctor voice” tones: the briskly professional, the warmly reassuring, and the gently regretful. Today, she drew on all three.
“From what I can see, your endometrial lining looks the same as last cycle. I know you were hoping for more progress. The medications are not stimulating a response.” She clicked on the mouse, scrolling down. “Everything I saw today tracks with what the findings are here. The fibroids are stable, but there’s no improvement. Your AMH is still low, but not zero. The endometriosis is behaving, which is a good sign, but…I don’t want to sugarcoat this.” She swiveled to face Poppy. Her brown eyes softening behind the glasses. “It would beverydifficult to conceive naturally.”
That wasn’t news to Poppy. She’d spent hours researching her own diagnosis, or should she say multiple diagnoses. Starting with Asherman’s, that benign but inexorable thief. Scar tissue, a little bit here and a little bit there, and suddenly the entire ecosystem was out of whack. She’d read the forums, the tear-stained blogs, and the “miracle baby!” stories that always ended in GoFundMe links or awkwardly cheerful product ads.
A decade of living with a uterus that could out-bloody a horror movie, and she could recite her own reproductive medical history as easily as others recited the alphabet. There was a time she thought these stories, the ones she related to, were unique, tragic, and somehow noble, as if enduring all the pain and suffering in silence would someday be rewarded. It started in her early teens.
She’d spent several days a month in high school doubled over in the nurse’s office, gritting her teeth through excruciating agony that made even breathing feel dangerous, the linoleum picking up her sweat as she waited for the Advil to kick in. Every single CVS employee knew her by name, and Poppy could rattle off the names and side effects of every OTC painkiller and every possible alternative treatment recommended by questionable online forums. At twenty, after she started working and finally got decent insurance, she was diagnosed with fibroids.
At first, the doctor had been so casual about her condition that she’d almost missed the gravity. “Your uterus is an overachiever, it decided to explore the rest of your body when it should have stayed home,” he’d joked. That first sonogram had been so grainy and indistinct, it looked more like a weather report than a medical image. They tried several treatments, but when those gave her no relief, he suggested “surgical intervention.” The words were scary, but she’d felt oddly hopeful. Surgery meant a solution, possibly an end to the cycle of agony. She’d watched too muchGrey’s Anatomytonotbelieve in the possibility of a medical miracle. Since she already worked as an x-ray tech, hospitals weren’t scary places to her. She scheduled the surgery, ignored the warnings on the paperwork, and told herself it would all be over soon.
The recovery was messy but manageable. She even joked about it. When Miss Carol, the woman who practically raised her, would text her to check in during her recovery after the surgery, she’d reply, “I’m fine, don’t ovary-act.” She’d also sent her a photo in bed with her heating pad on, saying, “Thanks, Eve, I hope the apple was worth it.” Miss Carol, who had been a Sunday school teacher for forty years, found it hilarious.
For a while, the pain did get better. She had entire stretches of nearly-normal months. She started running, joined a pottery class, and met Ronnie, who was the first boyfriend she didn’t have to offer a crash course in: “why I passed out on the bathroom floor in pain every month.” She let herself believe she was a regular woman, not just a collection of symptoms.
But the universe, as always, refused to let her off that easy. A few years ago, she’d been blindsided by a new set of symptoms, sudden, unpredictable bleeding, weird cramps, and waking up on the floor confused and groggy after experiencing excruciating pain. She ignored it for a while, tried to chalk it up to things she ate or not exercising enough, but then it got to a point that shehad to face the truth. Another round of ultrasounds. Another set of bloodwork. The phrase “secondary infertility” started popping up in medical notes, and this time the doctor’s voice was not so casual. Then they found the Asherman’s, the scar tissue had stitched her uterus together in places it should have been open, a literal web of her own body’s making.
She spent a few weeks reading Reddit forums and infertility subgroups, stalking miracle stories and horror stories alike, trying to find herself in the data. There were surgeries for this, too, but each one failed to deliver a real fix. She did the protocol anyway, enduring another invasive procedure, weeks of hormone therapy, and another cold, impersonal follow-up where it was gently explained that her uterus was basically an apartment with all the fire exits blocked. “It’s not your fault,” they told her. But the helplessness of being a cautionary tale was worse than pain.
And then the E-word reared its ugly head again, this time it was the “silent” kind. She didn’t even have the dignity of visible cysts or dramatic MRIs. Just a slow, insidious onslaught, each new scan confirming that her reproductive organs had declared open rebellion and only occasionally reported back for duty.
Poppy could see the arc of her life narrowing, options falling away with every appointment, every failed cycle, every “we’ll try this next.” She had never wanted to be one of those women whose personality got swallowed whole by one pursuit. One defining thing. For her mother, it was her father, who happened to be a married man with an entire family.
For her, she feared it would be the chase of a family of her own. She saw a future not yet lived, each year passed and each diagnosis calcified into the next. She realized how much she’d built her life around the idea of a noisy, sprawling family, the kind with overlapping generations and the smell of Thanksgiving in every room.
