IVF 8: Emotions

As several of you have commented on, I've been holding up well emotionally thus far. What helps:

--Dr Hyde is 100% supportive ("No, you go relax, and I'll do the vacuuming!")
--The doctors and nurses are friendly, happy to talk, and act as though they're delighted when I have an ultrasound on the Friday after Thanksgiving--really, where else would they rather be than at work, helping us try to conceive? Their positive attitude is reassuring.
--Talking with friends and blogging both provide a chance to let off steam, and to focus on the narrative and analysis, as opposed to the deep lurking worry.
--The drugs I've been injecting have been happily unable to mess with my head (aside from some kick-off headaches), to my relief. They're not making me all nutty the way that hormones can (although I anticipate the progesterone will be a different story).

Today, though, I'm starting to feel more anxious. In part this is because we spent yesterday hanging out with my cousins, one of whom is visibly pregnant. It's hard for me to see pregnant bellies anywhere, and a whole day of seeing my (younger) cousin was just dispiriting. The worst was when we went to the mall and inadvertently pulled into a parking space that read "Reserved for expectant mothers." The other people in the car cheered. "We've got one! We can actually park here!"

That side of the family is not known for its tact.

Another reason I'm getting antsy is that I am constantly reminded what we're doing, because my follicles have now swelled to outrageous size. Friday's recount (when I managed to stay solemn-faced) revealed 19 follicles on one side, 13 on the other. Today's ultrasound showed that the largest follicles are 16-18 mm in diameter. A little math gives us an approximate volume of 2 cubic cm for each one.

Did I mention there are 32 of them, all inside my abdomen? 64 cc of extra stuff in there? I feel bloated, full, and fat, and sudden movements provoke uncomfortable twinges. It's not awful, but I can't entirely forget about it, either.

Finally, today the doctor announced that the follicles were looking plump enough that we would probably do the egg retrieval on Wednesday. Although at some level I knew it would happen this week, the fact that there is now an actual date is giving me pause.

On the plus side, this makes me feel much better that the folks in the animal colony screwed up and killed my mice for this week's experiments. I was annoyed at them, but now I think--well, if you had to do that, good timing.

InADWriMo final update: OK

Nothing much happened on the paper this week. GradAdvisor had hoped to give me more comments before the T-day break, but she didn't. I'm not too annoyed; I know it's been a busy couple of weeks in lab. I just hope we can dig into the manuscript soon. It's my dream to send this off before 2009, though I doubt that will happen.

Still, I'm happy with the overall progress we made: a draft within the word limits, most references (that I could think of) in place, and the figures are finished or very nearly so. Yay InADWriMo and thanks for the nudge!

IVF 7: Ethics

I wasn't planning on getting into the ethical implications of IVF, but after reading some of the angry online comments to Alex Kuczynski's piece in the Times Magazine this week on gestational surrogacy, it felt pressing.

The arguments against IVF fall into three main categories:
1) If you can't have kids, there's probably a reason, and IVF only circumvents Nature by letting you pass that problem on to the next generation.
2) Why not adopt a child in need, rather than spend time and money pursuing "biological" children?
3) It's a giant waste of money and medical training for a problem that is not directly related to health.

In addition, there is a widespread perception (as reflected in the comments to the Times article) that couples who choose IVF are narcissists, people who cannot imagine loving a child that did not spring from their own loins.

Dr Hyde and I discussed all of these issues before deciding to try IVF. Some of these arguments have validity and still worry me; others don't. Let's take them in turn.

1) IVF circumvents natural selection.
First off, there are many reasons for infertility, and not all of them are heritable. Age, especially of the female partner, is the most obvious one, but there are others, including certain types of injury. Often, the cause of infertility is not known, making it impossible to say with any confidence whether it is heritable.

In our particular situation, we know the cause (or think we do), and doctors simply don't know if it's heritable. After all, it's only recently that couples with our problem have been able to have children. In this respect, we think of ourselves as being on the forefront of a giant experiment. Yay, experiments!

Would we still have tried IVF if we knew that any affected children would also be unable to conceive? I don't know. Of course, if we can conceive through unnatural means, then they would be able to, as well. Still, it's a heavy burden to put on them. There are no known health problems associated with our particular situation; if there were, we would have spent longer on this issue.

In any case, the point is that people who do have genuine, heritable health problems are not usually looked down upon for having children. Bad backs run in your family? Nobody says, "How dare you have children and put them at risk? Lower back pain is a sign that you are not genetically fit to continue the line!" So if you think IVF is immoral because it passes on bad genes, all I can say is: good luck defending your decision to propagate your family's hypertension, heart disease, bad teeth, and fallen arches.

2) Why not adopt?
Well, we still may. If a couple of rounds of IVF don't take, or if we want to add to the family later on but don't want to go through the medical hassle, we will adopt.

Adoption is not hassle-free, though. One friend who is working on her second international adoption listed all of the countries that have recently cut back on allowing babies to be adopted by foreigners. The list ran roughly, "All of them." Waiting lists are long, and if the rules change mid-process, you may not get a child at all.

I don't know anyone who has recently adopted domestically, but I do have one friend in her sixties who adopted her children in what she described as "the halcyon years for adoption--after the war but before Roe v Wade." I'm a firm supporter of all types of abortion rights, but there is no denying that legalizing abortion reduces the number of babies available for adoption. I have heard both good and awful adoption stories; like any method of acquiring a child, it's fraught with uncertainty.

Again, though, the proponents of adoption (in online commentaries, that is) usually seem to believe that infertile couples have a special responsibility to take care of the world's neglected babies. You just don't hear them saying, "Due to the population explosion and the number of needy children out there, everybody, including me, should adopt." No, somehow it's always the infertile folks who have to lead the charge of moral rectitude.

3) Should we really be using medical training for such a frivolous pursuit?
Three words: elective plastic surgery.

Now, I'm not of the belief that just because we can do it, someone else should pay for it. I don't think IVF should normally be covered under basic health insurance, because it's both expensive and medically unnecessary. However, Dr Hyde's health insurance is willing to cover one round of IVF, and we may be hypocrites, but we're not fools: we're taking the money.

4) You're all narcissists.
Interestingly, people often say this in the same breath that they claim that the only reason anyone wants kids is because society "brainwashes" women into thinking that they're not whole without children.

As a biologist, I find these statements make me laugh like a hyena. Wanting kids? Is normal, and biological, and without that drive the species would die out. Wanting kids that are genetically related to you? Again, totally normal. Adoption is, biologically speaking, somewhat perplexing.

Of course, we use our giant brains to make decisions that run contrary to our biology all the time, and thank goodness, because otherwise there might be more fighting, more rape, and fewer scientific conferences. But I don't think that someone can be labeled a narcissist for wanting biological children.

I'd also point out that the very fact that so many people are willing to spend $10,000 or so per cycle of IVF, even to go into debt for this purpose, says something important about our urge to have children. (It also says something important about the American willingness to go into debt, but that is more Ben Bernanke's problem than mine.)

I do think that some people have trouble knowing when to stop. When you are running out of money or ruining your quality of life by endless cycles at the infertility clinic, it is time to let go. But I can say that with sympathy, rather than with rancor or judgment. I can see all too well how difficult it would be to turn away from a particular vision you'd held of how the future looked.

It looked like an embodiment of the love between you and another person.

That's not easy to give up.

IVF 6: Pharmacopeia

A look at what's going into my body this month.


1 - Birth control pills. Two weeks of them to set my cycle.
2 - Prenatal vitamins. Duh.
3 - Baby aspirin. Voodoo. Daily voodoo.
4 - Lupron. Prevents ovulation. Started injecting it a couple of weeks ago.
5 - Follistim. Drives the follicle growth. Comes with a nifty pen-like injection device.
6 - Menopur. Ditto, but no pen-like device. More on it below.
7 - Novarel. One blast to ripen the follicles, right before egg retrieval.
8 - Vivelle. Estrogen. Fantastically, comes as a patch, like Nicoderm.
9 - Medrol. Somehow this helps.
10 - Progesterone. The dreaded intramuscular injection, for two weeks after embryo transfer.
Background - Sharps container and assorted syringes and needles, and alcohol swabs and gauze pads. More needles are hidden in various containers in this figure, too.

It's way more fun than any amount of sex.

Sunday was the first day of Menopur and Follistim injections (plus Lupron continues: three needle pricks, every day. But who's counting?) I had to laugh when I read the Menopur information. It turns out it's made from the urine of menopausal women.

I told Advisor this (as he has been both supportive and interested in the whole process of IVF), and he laughed out loud. "You mean, like witchcraft?" he said.

Anyhow, I had an awful reaction to the first Menopur injection. The subcutaneous injection itself stung a bit, as the Menopur is resuspended in 0.9% NaCl, and I have to inject 1 mL. The bad part, though, came immediately afterwards. I started feeling faint, and then nauseous. My skin was prickling and I broke out into a sweat. Sounds seemed to be coming from far away, as though I were underwater and Dr Hyde was trying to call to me from shore. In short, it was exactly the same reaction I once had to a shot of epinephrine (in an unrelated doctor's office procedure, to minimize some bleeding.) It didn't last long, but every minute felt prolonged, even dreamily timeless.

I can think of three primary possibilities:
1) Panic attack. This is the superficially most plausible explanation. However, I've never had a panic attack before, and I wasn't even feeling particularly apprehensive about the Menopur. As I say, the only other time I've felt this way is after an actual epinephrine shot. Of course, this whole procedure entails some stress.

2) Actual traces of epinephrine in the meds? Seems unlikely, but then again this is an extract, not a synthesized enzyme. Anything is possible, I suppose.

3) The follicle stimulating hormone and/or luteinizing hormone in the Menopur triggered a reaction. Again, doesn't seem likely but I just don't want to believe that this was panic. Given that I'm injecting in the abdomen, could a small amount have been taken up quickly and triggered a hypothalamic-pituitary-adrenal response? Dr Hyde, this time remembering his rightful job as my husband, said afterwards, "You know, you really don't have a lot of fat in the abdomen, so maybe it was taken up too quickly."

I don't think we'll ever find out, because I haven't had that response again. On the one hand, am obvs. happy about that; but the scientist in me sort of wants to see it occur again. N=1 is fun but not informative.

Today I also began the first of about ten days of daily blood draws at the doctor's office. (I am so, so grateful that the dr's office is within biking distance of my lab.) These are to monitor blood estrogen levels, and adjust medication dosage accordingly. While I was there, I ran into Dr Earnest Resident. "Good morning!" she said, and started laughing.

At least I am memorable, even if they do have "TROUBLE" written in all my charts now.

InADWriMo update: Rockstar!

Although I gave GradAdvisor the manuscript last week, she didn't end up having time to read it. But! she sent me an email explaining that she wouldn't have time to read it as promised, and what the reasons were (lab craziness).

So I spent this past week revising the manuscript, which had been a bit sloppy when I first sent it to her (lots of "(ref)" and half a figure missing). I photoshopped up some data (not in the illegal way), rounded out the last figure, and cut the manuscript down within the word count limits!

I sent it off to her yesterday, and she has already sent me preliminary comments, with promise of more insight before Thanksgiving. So far, this paper is the most swimmingly pleasant of any paper we've written (this is our third). Of course, I thought that also about paper #2 before it degenerated into a stony-faced stand-off, so we'll see.

IVF 5: In which I cause trouble

Today I had yet another ultrasound, this one to serve as a baseline for imaging my follicles over the next couple of weeks. Dr. Earnest Resident was plumbing my sparkle hole, while Dr. BigShot watched and grunted. Nurse Blondie was standing by, as of course was devoted Dr Hyde (who longs for the day when they let him run the ultrasound machine--we are both aching to push all the buttons on that sucker).

My ovaries were demurely tucked out of sight, so Dr. Earnest had to press on my abdomen as she moved the ultrasound wand at odd angles to get a glimpse of the follicles. “1, 2, 3…” she counted through my right ovary. When she hit “..11, 12…,” Nurse Blondie gave me an “aren’t you the impressive egg-layer” sort of look. The combination of the relief that I was producing plenty of follicles, the funny smirky smile on Nurse Blondie’s face, and the vaguely tickly feeling on my abdomen--I burst out laughing.

What happens when you laugh? Well, all your abdominal muscles tighten up. Dr. Earnest, who had been intent on the ultrasound screen, gave a startled “Ooh!” and scooted backwards as her hand flew off my now-rigid stomach, as though she were worried I had somehow ruptured mid-exam.

Then we all had a good chuckle. After everyone stopped laughing, Dr. Earnest had to restart the counting--it’s not like she could hold her place. This should have calmed me down, but instead I was beset by a horrid fit of the giggles. It was all I could do not to laugh some more, particularly after she re-counted my twelfth right follicle. I tried to think of sad things (dead puppies?) but the giggles are the giggles, and this was probably their least efficent follicle-counting mission ever. Not to mention when she switched over to the left side, and once again we reached 12--I was squirming with suppressed laughter, and Dr E eventually gave up after 14, saying to Nurse Blondie, “Let’s just call it 15+.”

I have to have perhaps four or five more follicle-measuring ultrasounds before they go in to retrieve the eggs (for which I will be anesthetized--and after today's performance, they'll probably want me two degrees warmer than dead). If the giggles recur, I will need to start bringing a Russian novel to the stirrups.

Team of Lab Rivals

There's been lots of talk lately about whether Obama is Lincoln-ishly shaping his Cabinet to include a spread of viewpoints, many distinct from his own, in order to avoid the self-reinforcing groupthink that can set in among like-minded people.

How well does such an approach work in the lab? I was thinking about this today when Advisor announced that he wanted to discuss possible plans for a New Fancy Microscope we might get. He wanted advice. (Actually, he only asked for advice from GradStudent and Other New Postdoc, but I elbowed my way into the discussion because I was in charge of acquiring an NFM in GradLab. Neither of the other two male trainees has done such a thing. So hmmmph.)

All three of us could be charitably described as opinionated. And it is the rare day that we are opinionated in the same direction. We get along reasonably well, but none of us would be mistaken for a retiring violet.

Accordingly, lively discussion ensued. We disagreed with each other's "facts," we disagreed with each other's interpretations, and generally hashed it all out at length.

At the end, though, there was a consensus about the steps forward. We all agreed that Advisor should get a quotation from a particular company, should look into the details of another company's product, and should talk with two or three people about their own NFMs.

I'm fairly sure that this debate served to identify some critical choices and to consider all options on the table. I'm equally sure that if any one of us had not been in the room, some of those options would have been discarded much earlier in part due to some people's "facts". So although my labmates sometimes rub me the wrong way, there's something to be said for this team of rivals idea.

If only we could achieve similar agreement over freezer defrosting.

Pizza and DNA

Those two things just don't go together, do they? Oh but they do, and it's called a Vendor Show.

I would love to work in industry just long enough to find out the profitability details on vendor shows. The economics of these things, especially the small ones that happen near-weekly at any large biomedical institution, have always baffled me.

Swarms of hungry graduate students and postdocs and techs descend like locusts on whatever free food is available. In the mornings you'll get coffee, bagels, doughnuts; lunchtime means pizza; afternoons there are sugar bombs in the shape of cookies or even ice cream.

The vast majority of attendees have not even a passing interest in the product being sold. I have literally never heard someone say, "Hey, I was thinking about getting a Promega enzyme, so I think I'll hit up their vendor show tomorrow for more information." In fact if I were to hear such a thing, I would fall off my seat laughing. Hello, Captain Internet?

I understand that food is, comparatively speaking, cheap. Perhaps a small vendor show, of the weekly bagel and coffee variety, costs ~$100. Pizza lunch, $150.

How much do the sales reps earn? They always show up in pairs, like Mormons, and their time probably costs the company what, another $200, taking into account travel etc? There's also the advertising flyer drop ("Free pizza tomorrow! Downstairs, outside the conference room!"). So we're only looking at an outlay of $300-400 plus some shiny brochures.

Still, I cannot wrap my head around how this junket is profitable. Sure, if just one attendee decides to buy their PCR machine, costs are recouped. But who decides on lab purchases based on the quality (or mere presence) of free chocolate chip ice cream sandwiches?

Of course, visibility is part of advertising too. Even if no one picks up your brochures (for use as anything but a brownie-plate, that is), you've still implanted the VWR brand name in their little skulls. In this sense, vendor shows are just like the adverts on the back page of Nature, only cheaper and probably further-reaching (who looks at the physical journal any longer?)

Nonetheless, I remain mystified that these biomedical companies regularly survey their entire operation, ask themselves, "What can we do to be a leader in the field?" and conclude, "Give away free pizza."

I would be happier with improved navigation on their websites, myself.

InADWriMo update: Ugh

I didn't get jack done on my November writing project this week. I did collect some data for a completely different unfinished project, so I guess that's nice, but only managed to read one paper for the November project.

I did do the rest of the my figure-scrunching very early in the week, though, so at least that gets crossed off the list. There's still one figure that hasn't been scrunched because it mostly hasn't been made. I'm supposed to be making a prettified picture from some imaging data, which leads me to my question of the day:

How can Photoshop be such a complicated menu-y program, and yet contain no simple way to average two (or more) images together? Yes, I know I can layer them all and adjust the opacities. Yes, I know I can "apply image" to add two images together. But why no straightforward averaging function?

(Perhaps it exists in modern-day Creative Suite. But I am using [don't laugh] PS 7.0, and it is like a tundra. For this, at least.)

IVF 4: Enter at your own risk

We are beginning the in vitro fertilization cycle, and as Abel "As you wish" Pharmboy requested, I am going to blog the daylights out of this sucker. The fun (?) part about IVF is that it takes ~6 weeks and encompasses many, many delightful procedures, so there will be no shortage of topics.

I will also post intermittently about Science during this time, and InAdriwriMoWhatsIts Progress, but this post serves as notice that if you visit this site any time between now and Christmas, you may be reading about my vag. The IVF posts will all be titled as such, as fair warning.

What you've missed so far: I had a hysterosalpingogram (= dye + x-ray visualization of my inner bits), and I have to say that I have the prettiest uterus ever.

Figure 1. Dr Jekyll's uterus really is this hot.

Ok, that's some other lady's uterus, but the sentiment is correct. Does it or does it not look like a beautifully filled pyramidal neuron? That is, if an apical tuft resembled a speculum. I was delighted, insofar as that was possible from my position. (This doctor's office, excitingly, didn't have stirrups but instead padded bars to drape your legs over. It looked sketchy but was actually way comfortable. Petition, ladies.)

Last week I had a "trial transfer," in which the doctor guides a cannula into the cervix and injects a little saline to mimic the procedure that will occur on the real embryo transfer day. Ahead of time, the nurse asked if it would be ok if a resident, rather than the Fancy IVF Doctor, took a turn. "Sure!" I said, ever eager to encourage medical education.

The resident had some difficulty figuring out a route through my (apparently labyrinthine?) cervix. "Ahah!" she finally exclaimed, after a particularly firm twist of the guide tube. "I'm through. I felt it."

"Me too," I replied. Oh, how we all laughed.

Today was the first hormone injection. I have been taking birth control pills for ten days now to suppress ovulation, and now we add in shots of Lupron, a gonadotropin releasing hormone agonist. This drives crazy activity in the pituitary, followed by a fall-off during which luteinizing hormone production is suppressed, as is ovulation. Don't want those little yolk sacs jumping off yet!

Anyhow, these injections are the easy subcutaneous ones. The nurse instructed us (well, me) to inject in the abdomen, after pinching up a roll of skin. Now, I've given many injections to many animals in my time, but of course I have a particular interest in getting these right. So this morning over breakfast I googled for more instructions.

Dr Jekyll: Hmm, it says on this website that you shouldn't do sub-Q injections in the abdomen if you're really skinny.

Dr Hyde: [breezily] I wouldn't worry about it. You're not that skinny.

[pause]

Dr Jekyll: Dearest, that's the sort of conclusion you're supposed to let me arrive at on my own.

MoranTech: We will never be rid of him.

While I was off Obamarama-ing, BlogFodder (ne Tech) was given a project to complete on his own. It was to be a repetition of the small project I trained him on the previous week, only with fewer of those complicated dilutions. The catch of course being that he had to do it all on his own, without my coaxing.

(For those of you who missed some of the later comments--if BF had been hired as my tech, he'd be out the door. But he's here mostly to do a project of Advisor's devising, and be an extra pair of hands for the rest of us when he's free.)

Against all expectation, BF performed just fine on his lonesome. The slides look ok, if not lovely, and he appears to have gotten the dilutions right, thus supporting the hypothesis several readers voiced, that he just goes all weak-kneed under my judgmental eye.

Today, Advisor was having BF look through the slides and compare them to an atlas. When I stopped by the microscope for unrelated purposes, BF asked me a couple of questions about the comparison.

Because I am a naturally bossy helpful person, I looked at his tissue, gave him a few pointers, and went about my business.

Later, Advisor came to me. "Jekyll, I am quite happy with BF. I gave him some slides to compare to the atlas and he appears to have figured out the best landmarks to use!"

Jekyll: "Ohhh. Um, I helped him out."

Advisor:[disappointed] "You helped him figure out the landmarks? So my test was not really a test?"

In other words, BF had his big test this week, and somehow I failed it.

InADWriMo 2 (Obama 63 million and counting)

I just fired off the revised and refined manuscript draft to GradAdvisor for a brief communication-type item. First InADriWriMo item, check!

I'm excited about the format--this is a paper whose previous drafts have given me heartburn, because it felt as though we were welding together two related-as-second-cousins experimental results. As a result, I always seemed to be shortchanging one half of the picture, or dwelling at excessive length on the other.

In a recent chat, I suggested to Advisor that we consider breaking the paper into its two immiscible halves--one as a brief communication with the flashy finding; the other as a regular length journal article with the more workmanlike "resolved outstanding issues in our subfield" part. After some discussion, we decided to give this a try. I am immensely more satisfied with the current version of the manuscript (flashy brief bits...mmmm....) since it no longer drags along the manacle of virtuous-but-slightly-dull Figures 3 to 6.

We are still missing one necessary bit of information (see to-do list item 3) but I don't think it will influence the manuscript dramatically, so this seemed like a good time to get this draft to GradAdvisor for first thoughts.

Incidentally, the journal we are planning to send this to recommends that the text not exceed about 1200 words. You thought I whined about the word limitations on the abstract of my last paper--skinnying this one down will be hellish. We're currently at 1470 words without any of the missing data....we'll see how this goes.

Yeeeeeaaaaaa

aaaaaaaaaaahhhhhhhhhhhhhh!!!!!!!!

Our swing state went blue! We had a very interesting time at the polls doing GOTV--we had a preprinted list of Obama supporters who were considered flaky (first-time voters, irregular voters, etc) and every time one came in we crossed them off the list.

Then at 2p we took the "walk list"--the houses canvassers were supposed to visit to get out the vote--and cleaned off the list anyone who had already voted in our precinct. In effect, making the last ditch 4pm GOTV effort more efficient and targeted by eliminating anyone who had already done their civic duty. Then we took the list and knocked on doors in one neighborhood, although everyone we chased down had already either voted or wasn't home. Still, we felt all participatory and stuff.

Around 5:30p we went back to the hotel and watched TV until Hopey won and gave his speech, and cried ourselves into a stupor (ok, the beer might have had something to do with it too.) The line about how his daughters had earned their puppy just slayed me. I mean, c'mon, PUPPIES.

Anonymoustache, nice job in in! Razor thin margins but it looks like you're holding on--amazing! JP, equal props to you for holding the margin under 10%, it appears.

Tomorrow a return to lab, and normalcy (?) Tonight, a bath of relief that--since neither Dr Hyde nor I is running for office--for the first time, I am actively proud of my country for something it did, as opposed to something it was.

Or as Dr Hyde says, "We don't have to leave the country!"

InADriWriMo 1; Obama 95

Two unrelated bits stuffed into one post:

On Saturday I hacked valiantly away at the Manuscript of Excessive Length, and I would say that all but the last two paragraphs (out of 10) are ready to give to GradAdvisor for a read. I also worked some on scrunching the figures, but haven't yet quite miniaturized them to my satisfaction.

--------

We arrived in SwingState yesterday pm with unreasonable giddiness. We are in an extended-stay suite hotel, with quite functional kitchenette. It feels a little like being at home, although obvs not. We are therefore referring to this as our Staycation Away From Home.

Yesterday evening we phonebanked for get-out-the-vote efforts. One of the phones we used had had the digits all rubbed off the keys, it had been used so much. We had lots of pro-Obama responses, with the only exception being some people complaining they had been called TOO MUCH by the Obama campaign. If this is our biggest problem, we are doing ok.

And I got to talk to a real live undecided voter! I don't know anyone in my normal life who is undecided or at least who is willing to admit that to me. This young woman said she was leaning Obama but she works in a doctor's office of McCain supporters who said that Obama would ruin health care. I talked her through some important basic points ("No, Obama is not going to socialize health care. Everyone with an employer-based health care plan, like you and me, will be able to keep that plan as long as they're happy with it") and she seemed to be happy to hear it.

Then she wanted serious details on how Obama was going to guarantee accessible health care for the uninsured and pointed her to the website (where she was headed anyhow--she said she was using this Sunday to read up on the candidates' positions on everything (!!)).