Rick only asked for the morning off for his appointment to receive his test results, but when the request was approved in the system, it had the full day set aside. He knows Shane's behind it, but in the end, he didn't argue. His brother knows this process better than he does by now. Good news or bad, it's something he needs to share with Amanda, and she's off on Mondays anyway.
The thing about doctor's offices is that no matter how good their poker face is, few are good enough to beat a trained law enforcement officer at learning what they're hiding. He knows, before he ever shakes the man's hand and takes the seat across from him, that he is not about to receive good news. Dr. Brown is one of Atlanta's most successful reproductive endocrinologists, and he probably should have come to the man's practice back when he first was assessed.
"Rick, I'm sure you're prepared for this news, but it's nothing promising." The older man passes Rick the printout he's seen before, back before he consented to a surgery that would no longer help save his marriage, but he had to follow through anyway. "If it were just one thing at issue, I would be more optimistic, but at this time, I would say that your chances of conceiving without intervention are somewhere about one percent."
"Why not just say impossible?" Rick asks, staring at the paper.
"Because in the thirty years I've worked in this field, I've learned that nothing short of complete removal of the reproductive organs makes it truly impossible."
"And what would the chances be if a partner and I tried IVF?" He thinks of Shane and Michonne, both so hopefully anxious to get out of the danger zone right now. It had taken four rounds of IVF to get them that far.
"Normally, we want at least a half million viable, mature sperm to attempt IVF. You're above that range, but only nominally so. The average sperm count is fifteen million, and you already know that anything below five million is considered extremely low from your prior treatment, correct?" Rick nods, and the doctor continues. "We could do a new sample collection, to get a second assessment, if you like. There could be factors at play such as needing more than two days abstinence."
Rick considers it and nods. "I can do that. At least if we get the same results, we know the final answer, right?"
"We would, yes. And if the results are the same, then IVF would be possible, but difficult. I would actually suggest Intracytoplasmic Sperm Injection instead, and it's exactly what it sounds like. Instead of introducing sperm to the eggs and letting nature take its course, we would directly fertilize the eggs. We could even consider collecting sperm directly from the testicles or epididymis, if need be."
Dr. Brown passes Rick a pamphlet. "These are the details for the ISCI procedure. I assume you aren't actively trying to conceive a child since you came alone for your appointments, but if you have a partner, I am more than happy to meet with her as well, now or in the future."
"When will I need to do the retesting?"
"I would recommend waiting at least four weeks, and this time, a five day celibacy period beforehand."
"Is there anything else I can do?" Rick thinks of the strict diet Shane's followed for over a year now, doing everything the specialists recommend to improve his and Michonne's chances. The problem is, aside from eliminating alcohol and the occasional sweets, he's already pretty austere with his diet for heart reasons.
"Honestly, I suspect there are few changes that could really improve anything. Your other test results have all come back within normal range, for hormones and anatomical obstruction or deformity. The varicocele surgery was the only viable solution before, and there's no indication of a return of the issue."
There's little more to discuss, not without other services being needed, so Rick makes an appointment to return in a month for the follow up analysis. Leaning against his car in the parking garage, he texts Amanda and asks if she'd like to meet for lunch. With Carl at Lori's this week, he'd spent the Saturday and Sunday night at her place, before stopping by his apartment to change before going to his appointment.
He can tell she's on alert when she parks her little Honda outside the restaurant he suggested. It's supposed to be the middle of his workday, yet he's meeting her at a restaurant near her house and dressed in a nice polo shirt and jeans, not the usual cheap suit he wears for work. Maybe he could have just showed up at her house, but he can't bring himself to have the discussion in either of their homes for some reason.
Amanda waits until they've ordered before she says anything, though, and she looks more worried than suspicious. Rick thinks he should count it as progress between them. Belatedly, he thinks about the pamphlet he left in the glove box of the car and wonders if he should have brought it in. Truly, that might be too much for this discussion, since he has no idea if Amanda is ready for that level of future plans.
"I thought you went to work today," she says, scanning his outfit as she sips from her glass of iced tea.
"I had a doctor's appointment this morning, and since I wasn't sure how long it would run, I took the whole day off. It didn't take as long as I thought it would."
"Everything okay?"
There's a spark of alarm in her eyes, and Rick remembers telling her about Lori's concerns for his heart with his family history. He smiles to reassure her. "Nothing life threatening. It was a follow up to something I should have done a long time ago."
Now that he's here in front of her, he has no idea how to get the conversation started. Saturday, they made a commitment of sorts to each other, but now it feels like they're back in first date territory. They've never discussed things like children at all, because he hadn't even had to introduce himself as a single dad to her. She loves Carl, and the feeling is mutual, so it hadn't been an issue at all.
Before he can get started, Amanda's phone rings, She glances at the display and pales, making him worry about what could flash panic across her face like that. "I need to answer that," she tells him, and he nods, feeling a little relieved when she takes the call at the table.
Rick is close enough to hear both sides of the conversation, since Amanda's phone is a nice enough one, so she doesn't need to explain that a doctor's appointment has been moved up. "How close is the office?" he asks, glancing at his watch.
She still looks a bit like a startled rabbit as she answers. "Over by Grady."
He sighs, knowing they can't squeeze in lunch if she's going to make it in time to take the cancelation slot she was just offered. "Go. I'll have them box up our food and take it to my place, if you'd like to come by afterward. Maybe we can swim? Enjoy the pool while the weather's still warm enough."
It's early October, and it'll be too cold soon, but one last swim actually sounds good if Amanda will join him.
"I'll let you know," she tells him, giving him a wan smile. She brushes a brief kiss across his lips before she hurries away, making him wonder if he should be worried about some complication from her injuries last month. Her mood had definitely gone downhill fast when she got that phone call. There's time to figure it out later.
Amanda nearly panics when the gynecologist's office calls while she is sitting at the table with Rick. He's got good hearing, so the odds he would overhear were pretty high. Luckily, the receptionist keeps it simple, only stating that a cancellation was made for the next hour, and she'd remembered it was Amanda's day off. Rick doesn't seem upset that Amanda bails on their lunch, which gives her time to call her mother on the way across the parking lot to her car.
Mama McGinley is waiting for her at the end of the path up to her building when Amanda pulls up, smiling gently as she settles into the passenger seat. She catches on to her daughter's nerves quickly, because she pats her on the shoulder as they navigate traffic. "It'll be okay, Mandy. You're just finding out a little sooner."
Swallowing hard, Amanda nods. "I think I may have been wrong about Rick," she admits. "That he's not interested in something long term."
"Oh?" The pleased note in her mother's voice is unmistakable, even in the single syllable.
"He came over to my place. Spent the weekend. We talked enough to know he wants to see where things are going with us." Amanda remembers the feel of his skin as he dragged her palm across his body, and that declaration that only she touches him like that. It makes her tighten her grip on the steering wheel involuntarily.
"Did that talk happen to include whether or not he wants children?"
Blushing, Amanda shakes her head. "Not specifically." Rick hadn't seemed panicked when he mentioned they'd forgotten the condoms, and they hadn't used them the rest of the weekend, either. Granted, she'd hedged the subject by telling him it was safe and kept it just to STIs, but still… Surely a man who really didn't want children wouldn't take the chance on not knowing the details of why they were safe, right?
Christ, she sounds like a damned teenager, too scared to directly discuss potential pregnancy with her first boyfriend.
Mama McGinley doesn't chastise her or ask for more details. She even saves Amanda's nerves by changing the subject and telling all about her neighbor's silly flirtation with a man young enough to be her grandson last Saturday. It's entertaining, especially since Amanda's met the irrepressible lady in question, and she's glad the man played along.
They reach the gynecologist's office, part of a larger medical complex where Amanda thinks she could go from office to office and get every part of her body checked out without ever leaving the building. Before they get out of the car, her mother takes her hand and smiles fondly at her. "I meant what I said, Mandy. You're going to make a good mama."
The easy confidence her mother has makes something settle at last for Amanda, so she's actually smiling when she signs herself in at the reception desk. The contentment carries her through the process for the urine and blood samples, and even makes her not feel like crawling out of her skin while she sits in the paper gown in the exam room, waiting for the doctor. Mama McGinley sits in the visitor's chair, calmly knitting something Amanda can't identify yet.
When the doctor enters, Amanda doesn't like his expression one bit, and neither does her mother. The knitting disappears into her purse as if by magic, and she leaves the chair to come take Amanda's hand.
"Normally, I would start out to lecture you a little because you're a year behind on your pap smear," Dr. Stuart begins, setting the tablet computer he's carrying on the counter. "But considering why you're here today, I'll consider that delivered." His gaze is kind as he looks between Amanda and her mother. "You told the nurse you'd had a positive pregnancy test on the twenty-fifth, correct?"
Amanda nods, feeling her mother squeeze her hand reassuringly. "It wasn't one of the digital ones, but it was pretty clear."
"I'm not sure if it's good news or bad, but neither your urine or blood tests are positive for pregnancy now."
"Oh." Taking a deep breath, Amanda tries to comprehend that. She's spent nearly two weeks working her mind around being pregnant and coming to not only accept it, but to look forward to it, and now it wasn't even true?
"I thought those home tests were almost foolproof for positive results," her mother states, stepping up when Amanda can't seem more than just one word in reaction. "Isn't it supposed to be the negatives that are false?"
Dr. Stuart nods, turning on the ultrasound machine. "That's why we're going to do an ultrasound to check things out. I've never had a blood test to be wrong, so we're going to check things out to see what's going on to have triggered the positive home test."
As Amanda lays back, she can't turn her head to look at the machine, her mother, or the doctor. She stares at the ceiling instead, ignoring the foreign feeling of the transvaginal ultrasound wand inside her. "What could cause it?" she manages.
"A few things can cause it, all of which need a physical exam. Blood or excess protein in the urine sample, certain medications, an expired test, letting the test sit too long before reading the results, pituitary disease, ovarian cysts, kidney issues…" He pauses, but then continues. "A chemical pregnancy versus a viable one, or a miscarriage. Have you had any bleeding since the positive test?"
The last two make her swallow hard. "No. Nothing at all." It makes this exam feel so much worse, and she finally rolls her head to look at the screen. Nothing makes sense on the black and white imagery.
"I can confirm you aren't pregnant," Dr. Stuart says, pressing a button to freeze the screen before withdrawing the ultrasound wand. "And I don't think you were. So we need to figure out what caused the positive test. I don't imagine you bought a bad test or timed it wrong. You were injured recently. What medications were you given after the shooting?"
Amanda lists off what she can remember, including that she'd had urine tests done on her exam to return to full duty last Friday. She probably could have gotten a pregnancy test run then, but that would make it part of her work record, and she hadn't wanted that, not yet. "I did take emergency contraception. Could it have caused it?"
"It would be highly unlikely. The hormones used shouldn't register on a pregnancy test. If anything, they'd be more likely to cause a false negative, I would think. The one listed on your records isn't hormonal, and there's no record of it ever causing a false positive."
"You forgot the dental surgery," Mama McGinley prompts as Amanda sits up. "She had a root canal the same week as the pregnancy test."
That makes Dr. Stuart pause and reach for his tablet to pull up a screen. "Did you have a local anesthetic or something else?"
"Conscious sedation." Amanda tries to remember the names of the drugs, but she had been in pain beforehand and loopy afterward. Rick would know them both, but she doesn't want to ask him right now. "I think one of them was Demerol, for pain, but it's the other I can't remember."
Tapping on the screen, the doctor nods thoughtfully. "That's usually used in combination with Phenergan. I think we've found our culprit. Phenergan is known for causing a false spike of HCG in women, and it can result in a positive pregnancy test if the test is taken soon enough after a large enough dose."
"I took the test two days later." Weeks of worrying, and it's her damned dental surgery that is at fault? Christ.
"That would be within the parameters for the Phenergan to still be in your system, since it generally lasts two to four days." He sets the tablet aside, studying her for a moment. "I wish that dental offices gave better information about the medication. It's a wonderful one for conscious sedation, but I imagine cases like yours are too rare for them to be proactive."
Amanda tamps down the feeling of overwhelming disappointment and nods. "I'm not sure I would have remembered if they told me. The Demerol made me pretty out of it."
"That's understandable. Taking Ella for emergency contraception can prevent ovulation, so the missed period is likely due to that. The question now is whether you want to start some form of birth control or not. I know you discontinued using a diaphragm after that series of urinary tract infections, saying we could revisit the issue if you needed birth control again."
That had been an easy decision, to just rely on condoms the last two years of her relationship with Luke. A baby wouldn't have been ideal, if a condom failed, but she'd never worried about Luke's sense of responsibility if they'd had a child. Now, after telling Rick they didn't have to worry about pregnancy at all, she's a little horrified. They'd had unprotected sex four times.
"I may need another round of emergency contraception," she admits, feeling guilty that her assumption led to another round of risk taking.
Dr. Stuart just nods. "Perhaps you should consider getting a copper IUD. It can act as emergency contraception if inserted within five days of unprotected sex, and then you're covered for future birth control. No hormones, so you won't have a repeat of the problems you had with the pills or the hormonal IUD when you were younger. When you're ready for a pregnancy, it can be removed easily, and there's no impairment on fertility to wait through."
Still trying to wrap her mind around the concept of not being pregnant after finally accepting and looking forward to a baby, Amanda agrees. The rest of the visit passes in a bit of a blur, and she declines her mother's invitation to come up for a visit when she drops her off at home. Instead of heading for Rick's, as they'd nominally agreed she would do, Amanda heads straight for home.
Crawling into her bed, where the sheets still carry Rick's scent from two nights spent alongside her, she cries herself to sleep, mourning a baby that never was.
When she wakes a few hours later, she's a little surprised to see Rick hasn't contacted her about their missed afternoon plans. Guilt flickers a little that she should have messaged him to cancel or at least delay them. The unexpected grief for a baby that isn't going to happen rears its head again, and she tosses her phone on the couch and goes to find something to eat.
Even that pisses her off for no good reason. She's faced with leftovers from last night's supper, the leftovers from shrimp tacos with a freshly made mango salsa. That reminds her that they'd eaten the food nearly cold, because cooking together had led to the bar height table being used as a brace for sex far more intense than they'd been able to do before due to her healing ribs.
She closes the fridge, ignoring the flash of sense memory of Rick behind her as she gripped the table for support, and goes to order pizza for delivery instead. The foul mood grows as time goes by and her phone stays silent, and even though she knows it's bitchy because she could text or call herself, she just can't bring herself to care.
By the time her pizza arrives, she's broken out the vodka, figuring at least she can drink if she's not pregnant. Two slices of the greasy meat lover's that couldn't be any further from the healthy pizza she's shared with Rick soothes some of her unease about how essential he's become to her. She's holding the phone and hovering over his contact when her mother calls.
The short conversation is well meaning and full of loving kindness, but it sets off the grief again. Nothing in her life seems to resemble what it used to be since she met Rick, and even the baby that terrified her at first, it's been taken from her. She sobs, hating the unstable emotions boiling through her and not wanting Rick to see her like this. At the same time, she craves having his arms around her, because it would feel like it wasn't so horrible then, having him close. She can remember how it felt when he held her after she was shot. He didn't have time to get attached to the idea of a baby, so how can he begin to empathize with the sense of intense mourning gripping her now? She just can't bring herself to make the call and be that vulnerable, not without knowing he would be as well.
Amanda opts for her vodka instead. She'll pay with a hangover tomorrow at work, but she just doesn't fucking care.
A/N: For those excited about the baby, alas, it was the plot from the beginning that there wouldn't be a baby in the mix. Inkribbon and I moved a lot of extra plot into the story, but that one didn't change.
And yes, Phenergan, used treat nausea and vomiting before/after surgery, does have a unique side effect of causing false positive pregnancy test results.
Where's Rick? That's a mystery for the next chapter.