When Dr. Stephanie Dahl returned to her native North Dakota after a fellowship in reproductive medicine further east, she imagined she would join the region’s only fertility clinic helping people make babies. Simple as that. In 2006, it was the only fertility clinic between Minneapolis and Seattle. She expected a flood of patients. What she never expected was a career transformation of sorts. This mild-mannered doctor turned into a political activist, thanks to all the renewed talk of Personhood. Personhood is an ancient term with a muddled definition. The word goes back to biblical times when philosophers tried to guess the moment a seed turns into a soul-filled being. The country thought the courts settled the debate with Roe v. Wade. That decision focused on viability, or the ability to survive independently outside the womb. But the word has crept back into political hallways. Lawmakers in several states have tried to pass bills that would give personhood a legal definition. And this is how some folks want it defined: Personhood starts the moment sperm meets egg. That means this single cell would the full rights of a U.S. citizen. So far, no bills have made it to law but the drawn-out process to block them seems to waste a lot of time and money that could be put to better use. To be sure, we know much more about  the innermost details of a growing embryo. But do these insights provide any information to help everyone agree on a revised personhood timeline? While most doctors perceive this as a threat to abortion rights—which  it is—the potential legislation also impacts the treatment of complicated pregnancies and limits infertility procedures. And that’s why fertility experts are worried. And that’s why Dr. Dahl has become an activist. And that’s why professional fertility associations have formed their own anti-personhood committees to defeat  potential legislation. If a person is a sperm-and-egg, you really can’t put them in freezers. That is what happens when doctors make extra embryos and freeze them for potential future use. And you certainly can’t discard them when they are no longer needed. At issue is not only the definition of personhood (At conception? At viability? At birth?) but who should be making the decision: scientists, courts or clergy. And if it is clergy, which religion? Beliefs on this issue vary as widely as the people who hold them. This past week, North Dakota senate passed two personhood bills, putting Dr. Dahl on guard once again.

Here’s a snippet of my recent conversation with Dr. Dahl:

RHE: Can you explain these bills?

SD: The first bill that passed the North Dakota senate would amend the N.D. constitution to read: “The inalienable right to life of every human being at any stage of development must be recognized and protected.” The vague language could lead to devastating unintended consequences for pregnant women and woman who’d like to become pregnant. The second bill limits some types of in vitro fertilization, criminalizes doctors, outlaws abortion with no exemptions for victims of rape or incest, and makes it difficult to treat ectopic pregnancies.

RHE: In your blog you mention cancer, what does that have to do with fertility?

SD: Chemotherapy and radiation therapy, which are used to treat cancer, can adversely affect the ovaries and destroy a woman’s ability to become pregnant in the future. The best option to preserve future fertility for women with cancer is to perform in vitro fertilization and freeze the resulting embryos. Some centers freeze eggs, however, that technology is not as successful as IVF and is not yet available at our center. Another bill introduced in the senate would have prohibited embryo freezing (for all families including infertility patients and cancer patients), limited the number of eggs we could attempt to fertilize (either one or two), and banned some forms of birth control. Luckily, that bill did not pass. Our cancer patients have enough to worry about with their diagnosis and treatment. They shouldn’t have to forfeit their chances of becoming a mother in the future as well.

RHE: Do you ever think it would be easier to move to a state with more progressive attitudes about fertility so you can just do what you do best?

SD: I have thought about leaving the state, but I want the people in North Dakota to have this care available locally. I think what we do is important. I love my job. When patients bring their newborns for me to snuggle, it’s the best part of my day. So I try to push the politics to the background. I’m here to give patients quality care. We now have thousands of babies across North Dakota that would not have been possible without interventions like IVF. But I hear comments from senators that you wouldn’t believe. Just the other day, one told me that if God decided a woman’s womb should not bear children, doctors should not intervene. And I said, “Does that mean if God decides you should have a heart attack, doctors shouldn’t intervene either?”

 

For further reading as well as thorough history of the personhood debates, check out 102-year-old Howard Jones’s latest book, Personhood Revisited: Reproductive Technology, Bioethics, Religion and the Law. Dr. Jones, sharp as ever, along with his late wife, Georgeanna Seegar Jones, created America’s first test tube baby and has been in thick of the fertility debates since  day one.

 

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After my girlfriend, Tracy, had her first bout of chemotherapy and after she got her appetite back, we indulged in a really decadent lunch. That’s when we decided we would eat our way through her ovarian cancer, splurging during her chemo holidays and when she was feeling good enough to enjoy a meal. (BTW, chemo holiday is the term her doctors’ used for the almost-normal days post-bouts of being drugged up and suffering the aftershock and pre-your next round.)

When we went for lunch, we talked kids, careers, books, and movies. We didn’t avoid the cancer talk. But we didn’t dwell either.

The other day on the way to the dry-cleaners, I ran into Tracy and she asked me to join her that afternoon for her head shave and wig fitting. How could I refuse?

And yet, I worried I’d sob the whole time and not be the support system she needed. Watching a friend have her hair removed is watching her parade into cancerland. Up until now, she may have been marching through hell but I was loitering in deep denial. We met outside her apartment at noon.

All morning, I had tried to image what a hair stylist majoring in chemotherapy cuts and cancer wigs would be like—particularly one on the tony upper east side of Manhattan. Tracy’s aunt was paying for her to get a top-of-the-line wig.

I imagined it would be spacious and white and pink. White for sanitary/medical. Pink for girls. Then I visualized the hairdressers. I pictured either (a) overly perky and saccharine-sweet chattering away in cheerleader diction to distract from the whole cancer theme (yuck!) or (b) overly soothing and sympathetic with airy yoga-teacher voices to make peace with all the bad stuff going on (equally yuck).

What we got was anything but cheerleader or yoga. And there wasn’t anything close to a slick paint job. We entered a drab apartment on the first floor of skinny walk-up. I’m talking no décor whatsoever. Pine-wood cabinets and tables with lots of wigs each one fitted on a head-shaped form. There were wigs on the table and wigs on the book shelves and rows of wig shampoo in the cabinet above the kitchen sink.

We were greeted immediately by the hairdresser. Again, nothing like I expected. Think Catskill comedian meets Italian Jersey shore. He said “Fahgettaboutit” and “you-know-what-I’m-saying” more often than someone doing a bad impression of how often New Yorkers say “Fagettabout” and “you-know-what-I’m-saying.” He bellowed when he spoke and put his face really close to yours.

In the old days, he said, when he was doing wigs “for like regular, crazy people,” the hairdressers really looked down on the wigmakers. “I mean it’s like putting a gay in the same room as Rick Santorum. Fahgettaboutit. You know what I’m saying?”

“Rita,” he hollered, “you can buzz her.”

His utter lack of sympathetic clichés made him all the more caring. He was loud and blunt and matter-of-fact and somehow that made the whole process a lot easier to digest.

Tracy winced when he started to cut her already short hair and she didn’t expect so much scalp pain. It hurt putting her head on a pillow, something her doctors never told her. That’s typical the first few days after chemo, her stylist said. (He knows. After all, he’s dealt with cancer patients for decades.)

But not to worry, he added. “Yeah, I think once your body gets used to, the uh, you know the tingling sensation, it’s like putting up with a tooth ache. After a couple days, you don’t even remember what it feels like not to have it.”

Well, that’s reassuring.

“When do you go for the next chemo?,” he asked.

“Tuesday,” said Tracy.

“So you’ll feel really sick on Friday. It’s mathematical.”

And, indeed, he spoke as if Tracy’s future was as predictable and straightforward as addition and subtraction.

I asked why he had a mirror in front of the chair. Did clients really want to watch as he buzzes? He said he swings the chair backwards for a lot of women but Tracy, he could tell was “well adjusted. You know what I’m saying?”

He doesn’t even have a barber chair, just a regular wooden desk chair with a swivel that makes him lean over so much it must hurt his back. Did he ever think of getting a chair that most hairdressers have that go up and down?

“Too Luciano,” he said.

The appointment lasted probably twice as long as we needed to be there, because there were so many stories. We heard about his visits to clients in their fancy Park Avenue apartments. Another woman, he said has trouble adjusting her wig. “And she went to Harvard. You know what I’m saying?”

“You know why she can’t adjust her wig,” he asked us (or really asked himself to lead into the next story) “Because she can’t cook. They order in all the time. If you can’t cook, you can’t fiddle with a wig. I don’t know an Italian man who would stand for that. My kids expect my wife to cook a three or four course meal every night. You know what I’m saying? Faghettagboutit.”

Tracy added that she’s worried about getting the wig on right and she’s a Harvard grad, too. But he wasn’t listening to us. He was busy with his own stories.

Then he pulled out her wig—a gorgeous, long, reddish piece with wispy front layers. He put it on but said he would need an hour, at least, to cut it down and fix the front. He suggested we go for lunch.

Before we left, I took a snapshot of Tracy with her pre-styled luscious red hairdo emailed the pictures to her boyfriend and relatives. She looked fabulous. Thanks to her hairdresser, I didn’t cry at all and then, as will be our usual, we went for another fancy lunch.

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P.S: Later that afternoon, when I got home, I did two things:

1. I did some online research to see if we know precisely what happens to hair shafts to make your hair fall out in clumps and if anyone is doing anything to prevent it. We’ve known for years that cancer drugs target cells that multiply fast—like your cancer cells and your hair cells, making your hair ridiculously breakable. But we still don’t know precisely—at the molecular level that is—what happens inside the hair. One scientist noted that his team is studying the impact to devise drugs to block hair loss. The problem, wrote Dr. Vladimir Botchkarev, in a 2003 article in The Society for Investigative Dermatology, is that “due to ethical problems in obtaining scalp biopsies from patients treated with chemotherapy, little is known about mechanisms.”

Let’s face it, after cancer surgery, cancer drugs, the devastating side effects, the hours and hours waiting around for treatment—not to mention the emotional upheaval of becoming a cancer patient—many women probably aren’t volunteering for a trial that requires scalping. A few drugs, he noted, seemed to prevent hair loss in newborn rats, but the same drugs were useless in older mice or human scalps.

2. I got inspired to grow my hair long to donate to places that supply wigs for children with cancer. There are several organizations, many of them outlines in this New York Times piece. http://www.nytimes.com/2007/09/06/fashion/06locks.html?emc=eta1

 

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