She shakes her head. Getting together with a sperm donor via the Internet would be too random. ‘I’ve no problem with dating online, believe me. I’ve been chatting to women
going through IVF on a forum too, and it’s been very helpful. The way everyone supports one another is fantastic. But it takes a long time to get to know someone that way, and my biological
clock seems to be ticking so fast. The fibroid might return if I leave it.’
‘I see what you mean.’ Howie peers into his empty cup as if the dregs might give him inspiration.
Then he looks up. ‘I’ve had a brainwave,’ he says.
Adam feels his mobile buzz in his pocket. Whoever it is can wait, he thinks. This patient is his priority.
He approaches the bed, his tread soft. ‘How are you doing today, Mr Malhotra?’
The old man is sleeping. Adam has visited this house several times over the last few weeks; it’s often the way.
‘He’s not been so good, doctor,’ says his wife. She hugs her sari to her chest, as if to protect herself from her own observation.
‘So what’s changed, would you say?’ Adam asks her. A glance at his patient reveals she is right: Mr Malhotra’s breathing is shallower, his lips are cracked and dry.
‘He’s not eating,’ says Mrs Malhotra quietly.
‘What, nothing at all?’
She bites her lip. ‘No.’
‘Oh dear,’ says Adam. ‘I’m sorry to hear that. You were giving him soft foods, like I suggested?’
‘Yes, I made him khichdi. But’ – she gestures to a bowl on the dressing table containing a pale yellow substance – ‘he has not touched it, you can see.’
‘May I ask, what is khichdi?’
‘Just rice and lentils and vegetables, doctor. Very mild. He likes it very much – especially when he is not too good. He says it takes him back to his childhood.’
She sighs heavily, and Adam’s heart goes out to her. He has faced similar situations before – there are a lot of elderly people in the catchment area of his Saltdean practice. Mrs
Malhotra’s husband has not long left, he can tell, and he knows she knows it too. The most he can do is to help make these moments as physically comfortable as possible for his patient, and
offer words of kindness to his wife.
‘A package arrived an hour ago,’ she says. ‘It looks like something from the hospital. It’s in the living room.’
‘I’ll go and see. You wait here.’
When he’s heading downstairs, his mobile vibrates again: whoever it is must have left a message. He returns to the room a couple of minutes later. Mrs Malhotra is still standing where he
left her, arms folded, in the bedroom. It’s the waiting that’s so tough, he thinks. He touches her elbow to bring her back to the present. She jumps, as if she’d forgotten about
him entirely.
‘It’s the drip I requested,’ says Adam. ‘I can set it up, but we’ll need some more light. Shall we open the curtains a little – do you mind?’
‘Of course, of course.’ She does as she’s bid, revealing a pink and orange colour scheme that sing-songs defiantly in spite of the dullness of the day.
He senses she’ll feel better lending a hand than watching powerless, so asks her to undo the smaller boxes. Removing the tape makes a ripping sound. Mr Malhotra’s eyelids
flicker.
‘Ah, you’re with us,’ says Adam, leaning close to his ear. ‘Good afternoon.’
Mr Malhotra gives a nod, barely discernible.
Adam assembles the equipment with practised speed. Mrs Malhotra tidies up behind him.
‘There’s very much packaging,’ she says.
‘It’s a terrible waste. I’m sure they could use less.’
‘I suppose they have to keep it . . . What is the word? Ah, yes, sterile?’
‘But still, can’t be saving the planet. Now, Mr Malhotra, I’m just going to insert a needle in the back of your hand.’ Adam raises his voice a touch, to counteract the
morphine. ‘Because we’re going to put you on this drip, here, see this?’ He wheels the apparatus to the side of the bed.
Mr Malhotra is so doped up he probably won’t feel anything, but Adam is aware his wife is flinching, so acts as fast as he can. Presently the tube is in place; he examines the bag to
ensure the liquid is getting through, checks there is adequate pain relief in the machine and turns to her. ‘There. Done. That should help.’
They pull the curtains closed again and go to the door, turning in unison to check before they head downstairs. Sure enough, Mr Malhotra is asleep again.
I hope he is dreaming of khichdi, thinks Adam.
* * *
Cath fixes her gaze on a crack in the wall. She feels a prick in the crook of her arm, hears the rustle of starched fabric as the doctor reaches past her.
‘There, done. Just press for a moment, if you wouldn’t mind.’
She wedges the pad of cotton wool firmly against her skin, looks round. Dr Hassan is focused on labelling several little vials of dark-maroon liquid.
‘I didn’t realize you were taking so much.’ In spite of everything she’s been through, seeing her own blood still spooks her.
Rich is sitting close by, looking apprehensive. ‘What are you going to do with it all?’
‘Given we’re going to use donor eggs in your wife’s case, we do standard tests for the blood group, hepatitis, HIV, rubella and chlamydia. We’ll check your blood for the
same things. We’ll also check you for cystic fibrosis.’
‘So do you test the donor for exactly the same things too?’ asks Cath, at once captured by the thought of another woman going through a parallel experience. Will she see the same
doctor, sit in the same chair?
‘Yes, but we also look at their hormone levels, as they can tell us about the fertility of their eggs.’
‘She’ll be younger than me though, won’t she?’
Dr Hassan nods. ‘We don’t accept donors over the age of thirty-five because there is an increased risk of Down’s syndrome.’
‘How long will it take to find someone?’ asks Rich.
‘Well, we have to make sure they are a good physical match. I aim to oversee each patient personally.’
That could take ages, thinks Cath. She’s eager to get going.
The doctor seems to pick up her mood. ‘Hopefully it won’t be too long, but two or three months is the minimum, really. I should warn you that it can be as much as a year.’
‘A
year
?’ How on earth can they wait as long as that? She’s forty-two!
‘Hopefully it will be much sooner.’
‘So how like me will my donor be?’ Again Cath feels the presence of this other woman, almost as if she were in the room. She wonders where she is at this moment, whether she’s
been to visit the clinic already.
‘We’ll take into account your height, skin tone, build and hair and eye colour.’
How eerie, thinks Cath. There’s a mirror woman, then, somewhere out there, with mousy hair and blue eyes. ‘You can match me with someone thinner if you like.’
The doctor laughs and turns to Rich. ‘We’ll take you into account as well. You both have blue eyes, so we’ll avoid pairing you with a brown-eyed donor, if we can.’
‘Makes sense,’ says Rich.
Cath is still thinking of the mirror woman. It’s all very well pairing us physically, but what if she’s nothing like me otherwise? What if she is stupid, or bigoted, or bad at
everything I’m good at? If she hasn’t an artistic bone in her body, or is silent and aloof? Though surely Rich and I would influence a child by spending time with them anyway. If he or
she is brought up in Leeds, they’ll have a Yorkshire accent no matter where the donor lives.
The doctor interrupts her thoughts. ‘You do need to understand that we’ll have to harvest ten eggs from the donor to allow her to share them with you.’
‘How can you guarantee that?’ asks Rich.
‘We can’t, obviously. But that’s why we check every donor, to make sure there’s no imbalance or anything that might prevent them producing eggs. Then we stimulate their
hormones to make them produce more.’
Cath frowns. ‘So what’s the usual number of eggs harvested after that, then?’
‘We aim to get at least ten; it’s often more.’
‘What if there’s an odd number?’
‘We usually give the extra one to the donor, for obvious reasons. This is something you should talk through with our counsellor, so you can think about it seriously before you go
ahead.’
You’re telling me, thinks Cath.
‘We’d also recommend that you consider the option of ICSI, to maximize the chances of success.’ He pronounces the word ‘ick-see’.
‘What’s that?’ asks Rich.
‘It stands for Intracytoplasmic Sperm Injection.’
‘I’ve seen that on the telly,’ says Cath.
‘Quite likely,’ says the doctor. ‘In traditional IVF, many sperm are placed together with an egg, with the aim that one of the sperm will enter and fertilize it. With ICSI, the
embryologist takes a single sperm and injects it into an egg with a sort of needle.’
‘And the needle doesn’t harm the egg?’ asks Cath. She seems to recall reading something about increased risk of birth defects with ICSI.
‘There’s been some research into it, but the studies are inconclusive,’ says Dr Hassan. ‘It’s often used for men with a low sperm count, for instance, or poor sperm
movement.’
‘But there’s nothing wrong with my sperm,’ says Rich, indignant. Cath is momentarily stung that he should seem so defensive about it. Then he adds, ‘Or not as far as we
know.’
‘No, no, I appreciate that,’ says the doctor. ‘But here we use ICSI in other circumstances, such as egg sharing, too.’
‘Is it more expensive?’ asks Rich.
‘Slightly,’ nods the doctor.
‘How much more is it?’
‘About £800.’
Cath’s heart sinks. The bank was unwilling to lend to them as it is.
Dr Hassan reads her expression. ‘In the long run it’s often more cost-effective for egg-sharing couples, because of the excellent success rates.’
‘So we’re less likely to have to come back?’
‘Exactly.’
We’ll do the sums later, thinks Cath. She pushes on. ‘Is there any difference in terms of the treatment?’
‘Not really, since ICSI is done in the lab. We wouldn’t recommend it if we didn’t think it’s likely to produce a better outcome, but by all means look into it yourselves
and discuss it with your counsellor in due course.’ He turns to Rich. ‘So, as we’re on the subject, perhaps this might be a good moment for you to produce a sperm sample? You can
do it while I give your wife an ultrasound.’
And before Cath has a chance to say she’d like her husband to stay, the doctor has handed Rich a jar and sent him off down the corridor.
As Adam gets back in his car, he remembers that his mobile rang earlier and whoever it was left a message. He’s been longer with Mr Malhotra than he had intended, so
clips in the earphone to listen whilst driving.
‘Wotcha doc,’ says a familiar voice. ‘It’s me. I’m sitting in our favourite haunt – the Kemptown Bookshop cafe – with my friend Lou. Remember her?
You’ve met a few times. Anyway, we’ve just been talking about something that I think might interest you. She’d prefer for me not to go into it on your voicemail, so call me back,
as I think it might interest you . . .
very . . . much . . . indeed
.’
Get on with it, mate, thinks Adam. Some of us have jobs to do. Nonetheless, his curiosity is piqued. He cuts the voice-mail short and presses ringback.
* * *
‘I’ll pass you over,’ says Howie.
Lou takes his phone. ‘Is that Adam?’
‘Yes, it is. Lou, hello, how are you?’
Lou feels stupidly nervous. ‘I’m good, thanks.’ She’s often sought out Adam at Howie’s parties, finding him refreshingly open and easy to talk to. She says to
Howie, ‘I’m sorry, but I’m just going to take this outside.’ It might seem mean excluding him, but she’s justified, surely. She heads out of the bookshop and onto the
pavement. It’s very blowy – St George’s Road runs parallel to the seafront – and there’s the noise of traffic, but at least it’s just the two of them. ‘Is
this a good moment?’
‘I’ve a few minutes, yes. I’m in the car on my way to see a patient.’
She’d much rather meet Adam in person, and she’s barely had time to prepare herself for the call, but unless he’s interested there’s no point going further. He sounds
busy, so she tries to be swift. She explains that she’s poised to undergo IVF and wraps up by saying, ‘I understand you’ve been asked to father a child before but said no, is that
right?’
‘Kind of . . . Initially I said yes, actually. One of my closest friends, Evie, and her wife, Nikita, asked me. I think you might have met them at Howie’s last bash, too. They live
in Hove. Anyway, now they have a little boy, and Nikita is expecting another baby soon, but before that, when they were seriously discussing having children, they approached me about being a donor
to both of them; the idea was each would get pregnant and have one child. Hold on a moment . . . ’ There’s a pause. ‘Sorry, that was a roundabout.’
‘So why didn’t you go through with it?’ Howie has already outlined some of this, but she’d like to hear it from Adam.
‘Well . . . at first it seemed like a great prospect, so I went and donated sperm, had all the tests and got it frozen and everything, you know?’
Lou has done her research and is aware of the protocol. Any ‘
known donor sperm’
, as it’s called, has to be quarantined for six months before it can be used. The same is
not true for spouses or partners, but it would be a legal requirement for someone like Adam.
‘Anyway,’ Adam continues, ‘so I was very into the idea, but the more we talked, the more I came to understand the implications. Really what they wanted was that they would be
the parents and I would have some kind of loose uncle status, no more.’ He sighs. ‘Why are you asking?’
She answers with another question – she doesn’t want to give too much away until she’s more sure he’s onside. ‘So let me get this straight: you
might
be
interested in becoming a father . . . in the right circumstances?’
‘Yeah, I suppose . . . I’ve sort of always seen myself as having kids.’ Lou gets why: his warmth and openness is why she gravitated to him at social gatherings herself.
‘But with my friends, I decided I couldn’t see a child all the time knowing I was the father, so I pulled out. Frankly, I’d rather donate anonymously to a couple on the other side
of the world. Though actually . . . hang on, another roundabout . . . ’ Lou is on tenterhooks. ‘I wouldn’t do that either. I couldn’t be that detached. I find it hard enough
with some of my patients, let alone my own offspring.’