Wednesday, September 27, 2017

week 17 - harmony test #pregnancyDiary

So my last updates ended up being pretty long! Well done to those of you who made it through the entire thing. It's making me wonder whether I should break up the weeks into smaller chunks so that's what I'll try now.

Week 17 thoughts

I've been experiencing pain on my right hand side above my hip. At my last appointment I mentioned to my doctor that I'd had various cramps and pains but in general they weren't severe and usually went away and he didn't seem too concerned. The next day the pain on my right seemed to get worse! I noticed it more during movement such as when I'd get up from sitting or turn around in bed during the night. It felt sort of like a stitch or pulled muscle. When it didn't seem to go away I started wondering whether I should go to the hospital to get checked out (this was outside my doctor's opening hours). I had more or less decided I would go to the hospital when I was googling and started reading about something called round ligament pain and realised that's exactly what it felt like. I also messaged several friends who'd had kids to ask them if they'd had something similar. Some hadn't but the majority had. I decided I would wait and see if it got better and luckily it did. I still notice it sometimes but it's not as painful. It seems like aches and pains are to be expected!

Even though I am feeling delighted to have reached 17 weeks, the anxiety hasn't gone away completely. Instead of worrying about miscarriage I've started fearing something going wrong at the birth, even though it's ages away. I've had two surgeries in my lifetime and I have a lot of adhesions and scar tissue as a result. I was told after the operations that the adhesions around my intestines could cause a blockage at any point and that would require emergency surgery. I was googling and saw that although adhesion surgery during pregnancy is possible it carries high risk of infant death and even maternal death. I decided to stop reading those articles! I did take serrapettase for a few months before getting pregnant so hopefully that dissolved some of the adhesions. And there is no point worrying about something that please God won't happen! Stillbirth is another worry. It's not such a far fetched thing as it happened to one of my best friends from home.

I am trying to not think about all those things as obviously worrying and stressing isn't good. I doubt I'll be able to fully relax until our baby is actually here safely. I've been trying to remind myself that so far my body has done what is is meant to and everything has been fine. When I share some of my worries with hubby, instead of telling me that the things I'm anxious about are really unli kely or whatever, he starts to look worried too. So I don't think he's the best person to share all my anxieties with! I think the next time I'm at my gyno I'll tell him about my worries in terms of my previous surgeries having an impact and hopefully he'll give me some reassurance. Anyway later today I'll be phoning my doctor about the harmony test results. I'm feeling a little anxious and really hoping that will all be fine.

Next day

So the update is I must have phoned the doctor about thirty times yesterday but couldn't get through! He has certain Sprechstunde (available speaking times), just a short window really. 4.30 till 5pm on Monday and wednesdays. I had to get to work extra early that day, take a short lunch and rush home in order to try to make that time slot. At first the phone was engaged every time I called. Then finally at 5pm I got through but no one answered, making me wonder whether he just ran out of the door once the window has closed! I tried several times after but still no joy. It was frustrating as we really just want to get the results of the harmony test now to find out if everything is ok. This morning I phoned and was told that I can only be given the results by the doctor and "that's what his Sprechstunde are for". His receptionist can be a bit snarky. I explained how I HAD phoned. She said he's busy today and not there tomorrow so we have to wait till Monday and try again then. Frustrating!

Anyway, I guess I am used to having to work on my patience by now so whatever. I decided I'll hold off on telling more people in the office till next week. Actually I did read that some women don't tell work till they are 20 weeks. They probably wait until after the anatomy scan then. Depending on your figure, it IS possible to conceal the pregnancy. I take back what I wrote before saying it is very hard to hide. I do have a small "bump" but it doesn't look that different to being bloated or whatever and unless someone is looking for it it's not so obvious. There was a team lunch I was at a few weeks ago where the waiter brought us all a digestive shot to drink after the meal, with alochol. I turned it down but so did some other colleagues who didn't want to drink during their work day so it wasn't so noticeable. And even though I've been nasueas, I haven't had to throw up at work luckily, only at home!

The majority of my friends here already had kids (most have two by now). It would have been nice to have gotten pregnant at the same time as some of them. However I love this baby now and I'm not going to live in the past wishing it had happened sooner. I do have one friend here who is two weeks behind me though! I met up with her yesterday which was really nice. We are going to try to go to the same Geburtvorberitungskurs (birth preparation class) in the hospital if possible. Most of the courses have already been booked out! We are hoping to get the one starting November which goes on till January. It'll be two hours once a week.

At my husband's work there are more pregnancies too. I am surprised at how fertile all his work colleagues seem to be. It looks like we are the only ones who had difficulties, judging from how soon most of them seemed to have gotten pregnant after their weddings. Nice for them not to have to deal with infertility of course! Sometimes I feel a little sting at people who are easily able to have several kids wheras we have accepted that we'll most likely just have one. And I hate when people make comments about only children being lonely or how it's selfish for parents to only have one. I can imagine that our one will be very happy! We can make sure to go on plenty of "play dates" and maybe get a pet at some stage.

Later that week

I've noticed that I've been feeling much better in general! It's like a fog has lifted. I don't have the nausea as bad at all anymore and I'm feeling more energetic. I guess this is why the second trimester is considered the "honeymoon" phase! I had a productive week in work on a big project and was feeling very proud of myself. So overall it's been a good week. I've even been more social too. Now I'm not as exhausted all the time, I've started meeting up with friends more often which is fun.

Hubby finally managed to get through to our doctor and we found out the results from the harmony test. Everything is great! The baby only has a 0.01% probability of any of the three major defects. Such a relief! I'm glad now we did decide to go for the harmony test in the end, it's so nice to have that peace of mind. The doctor even said that the results were hervorragend meaning excellent. We already feel like proud parents! My thyroid levels were also fine - TSH 0.7. And my iron levels are a solid 12.2. So good news all round.

Monday, September 25, 2017

What I've been eating lately

Yes, I'm one of those annoying people who takes photos of their food in restaurants before eating! Anyway I thought I'd share pictures of some of the meals I've enjoyed lately while eating out or at home.

Firstly, pumpkin risotto. Yum. I'm a big fan of risotto. Love it with mushrooms or pumpkin in particular. This one was covered in lots of parmesan cheese too. (Meaning I had to take several lactase tablets but so worth it!) This was eaten an international restaurant chain with Italian cuisine, Vapiano.

Another time I had a burgerless burger with avocado sauce and salad. I generally love all things avocado. This was at another restaurant chain, though it's only in Germany as far as I know, called Hans im Glück (happy Hans!). I got the burger bunless as I wanted to avoid any gluten. I also didn't get any cheese as I was trying to be dairy free that day. It came with a vegan sauce.

At home I cooked a yummy vegan meal recently; butternut squash, lentil and spinach curry. I was loosely following this recipe and it turned out really well. Hubby said it was "delicious". The following day I used the leftover squash to make a carrot and butternut squash soup by basically throwing it into a pot along with ginger, onion, garlic, vegetable stock, italian herbs, turmeric and black pepper then using my smoothie maker to blend it once it was soft. I also added coconut milk so it would be creamy. That's a good cream alternative when you are dairy free.

I made myself a healthy salad one evening with rocket leaves, cocktail tomatoes, cucumber, walnuts, avocado and cheese. For the dressing I used olive oil, a little lemon juice and basil and oregano with black pepper.

My husband and I eat a lot of vegan meals as we try not to eat a large amounts of animal products. When we do eat meat, then ideally it's organic and not processed. This was gnocchi with mediterranean veg and rocket leaves at the vegan place in town.

I've got quite a sweet tooth. Dessert used to be my favourite course when I was younger! This is a gluten free carrot cake I enjoyed recently with a caffeine free cappuccino and soya milk.

Tuesday, September 12, 2017

weeks 13 - 16

Trigger warning: pregnancy discussed.
I just wanted to say that I'll be continuing to share my thoughts on this pregnancy every few weeks. If you are at a place right now where you find reading about this hard or upsetting then please skip these posts by all means and look after yourself. I understand completely. I'm planning to continue to separately blog about non pregnancy related stuff also.

Week 13 thoughts

Some people consider week 13 to be the official start of the second trimester, for others it's week 14. Baby is now the size of a fig! I actually don't have much of a "bump" yet which is probably just as well since only a select few people at my office know yet and I don't want it to be too obvious. Once we have the 16 week scan, provided everything is fine, then I would start telling more people at work. It still feels like such a personal thing though.

I haven't really been doing that much lately. I still get tired pretty easily and evenings after work I often just feel like relaxing with a good book or in front of the telly. Last weekend himself and I spent Saturday catching up on housework and chores and just hanging out. Sunday I met up with some friends. One of them lent me a pregnancy book. There was a section at the beginning about getting pregnant. I had a look through it and felt like laughing as all the information just seemed so basic to me - for people who don't have a clue about fertility. I could easily write a thesis on all I know by this stage! I still feel a little jealous sometimes towards the women for whom pregnancy came easily and without problems. Don't think that will ever go away completely. I joined a group of Irish women on facebook who are also due in February as I heard it can be a nice way to make friends. Quite a few are on their fourth child already! It's not that I particularly want to have four kids, I'm just jealous of how nice it must be to be able to plan and choose how many children you want and when to have them.

I continue to be grateful for this pregnancy. Sometimes I feel guilty too. Sort of like survivors guilt. I know there are so many great people out there who are still trying or have since resolved child free and I'm really sorry when it doesn't happen for them. I'm certainly not in any way more 'worthy' than anyone else. I also don't even know for sure what was the winning combination that helped it work for us this time. It could have been changing clinics and the new approach, it could have been all our healthy eating and the fact I went gluten and dairy free, it could have been the melatonin tablets which improved egg quality or the DHEA I took for a few months beforehand or all the extra prayers! We'll never know for sure.

Sometimes I think the nausea has gotten much better and then I get it again. Brushing my teeth often makes gag and feel like I might need to throw up. I went into H&M and had a look at the maternity section. I felt a little like an imposter, like someone might tap me on the shoulder and ask me what I was doing there. They had some nice things but I didn't feel ready to buy anything yet. So far I've been making do with some jeans I have that are not tight around the waist, plus doing the hair bobbin trick where you put a hair tie around the button and through the jeans hole. And I've been wearing longish tops.

I've been thinking today again how lucky we are. I had lunch with a friend (let's call her J.) who's friends with a fertility doctor at a clinic in Munich. She often tells me stories of her patients. J also told her doctor friend about our story. When she heard about us considering the immune protocol, she was all for it, saying she had seen that help in lots of cases. I'm talking specifically patients who have had immune related issues diagnosed when they got extra blood testing done. Anyway I asked J. if she had updated her doctor friend about our pregnancy. She said she had and her friend was really happy for us but also surprised. She had thought based on what she had heard about me (previous surgeries, poor responder etc) that it wouldn't work until our 8th IVF attempt!

The fact is we wouldn't have done eight rounds. We decided that the fourth would be our limit. We couldn't keep putting ourselves through it. So yeah I was just thinking today how incredibly lucky we are that the fourth attempt seems to have worked so far! Somehow our baby now exists and is growing. Things could easily have turned out differently. I'm not saying that the alternative would have been an awful future or anything, we would have found ways to move forward, but I am incredibly glad that this little baby seems to be a fighter and please God will get born in six months time and join us!

There are plenty of fertile people who take their children for granted. After going through the journey we did (and seeing what other people go through), we are well aware of how precious each life is! The timing is everything too. If we had done IVF a month earlier or later, it could easily not have worked. It wouldn't be this exact unique baby created from that particular egg and sperm. This new person (with a soul as that's what I believe) exists now and there is just something so incredible about it. It began with a bunch of cells which kept multiplying and then started forming things like a head, brain, spine, liver, kidneys. Each cell knowing exactly what it's meant to do.

Week 14

I am officially in the second trimester now! How cool is that? From what I've read this is the most fun time (the honeymoon period) as you are meant to start having more energy, less nausea but don't yet feel uncomfortable. It'll still be several more weeks until I can feel any kicks probably. That seems unreal to me, the thought of it! I have gradually been reducing the steroids and right now I am only taking 2.5mg - barely anything. Unfortunately reducing the steroids also meant my nausea seemed to get a bit worse I noticed! From about 5pm till 8pm I feel particularly crap. Being in the office at that stage isn't fun. Like I mentioned before lots of snacking helps. I had one evening where I was leaving work around 7pm and pretty much had to hurry as I was worried I might throw up in the office! Thankfully it passed and I got home and ate something immediately and was ok soon after.

Hubby doesn't feel comfortable with me flying anywhere so he would prefer for us not to go to Ireland until after the birth. He pointed out that "we only have one shot at this". I don't want to do anything to make him feel uncomfortable and of course our baby's health has priority but it's moments like this where I feel the distance from home. Well, this is my home now of course, but I wish I could see my family more often. However I am hoping they will visit me which would be great. I haven't totally ruled out the idea of an Ireland trip but it's looking less likely at the moment. I also need to apply for a new Irish passport as mine is expiring in a few months so need to get that sorted asap. I already phoned the nearest Irish embassy and requested they send the form out.

It's still two weeks till my next scan and as usual it feels like a long time. I'd just like to know baby is ok in there. But I am trying to remind myself there is no reason to worry. I did use the doppler again last night. This time I was able to find the heartbeat fairly quickly though only for a few seconds which makes me wonder if the baby doesn't like the doppler ultrasound waves and is moving away from it. Every night when I'm in bed, I "talk" to the baby. I'm trying to get him/her used to my voice and already start teaching him/her my accent, haha! I just really want the baby to have a strong Irish identity despite living in Germany. I also looked up some Irish folklore children's books which we could read together one day. Traditional Irish stories have a fair bit of violence though. It's a bit like the Grimm fairy tales. There are lots of battles and superstitions! "The children of Lir" is one story which sticks out in my memory.

Hubby and I have discussed how we would split the parental leave. We are thinking that the first month we would take off together then I would stay at home for about six months after that and then I would go back to work with reduced hours if that's an option (it should be but need to talk to HR) and then hubby would stay at home the few six months until baby is about one. I am delighted that hubby wants to spend that time with our child, I think it will be really good bonding experience.

In other news my little sister got engaged! Yay! Very excited for her. Her and her fiance are thinking about a small beach destination wedding which sounds fab. It's crazy for me to think that next summer we could be attending her wedding with our baby. I still feel nervous sometimes thinking too far ahead about the future, though at the other time it is lovely to imagine. I know it won't all be amazing of course, I'm not totally naive. I've followed blogs of women after they have their baby, plus I've heard from friends and I have seen how hard the first few months can be. The idea of childbirth is a bit scary too!

I already had to try to book a "Hebamme". The direction translation is "midwife" but they don't usually attend the birth. It's all a little alternative. You can go to the Habamme here instead of your doctor for your checkups and your health insurance would cover it. The main thing they do though is come visit you after the baby is there and help out. A certain amount of visits are covered. And they offer classes such as "Rückbildungskurs" with exercises to help put everything back into place after birth! And some offer things like pregnancy yoga too. Anyway they are really hard to get as they get booked up really fast but I've managed to find one a friend recommend who's going to visit in a few weeks to meet me.

I went back to H&M and this time bought some maternity shorts and "mama" tights which were reduced. The shorts are really comfy! The weather has changed from summer so I only wore them once and then started thinking that buying shorts might not have been the best idea. However I tried wearing them with tights which was a cute look.

Week 15 thoughts

My gyno is finally back from his holidays after about a month! We phoned on Monday to try to get our blood test results but the practice assistant said he was busy and to call back Wednesday. Wednesday hubby phoned and it turns out the doctor never did the first trimester screening blood test as we thought! He only did some sort of standard blood test. Needless to say we were rather annoyed about it! When we had phoned the following week we were told the results weren't there yet and the next time we called were told we'd have to wait till after his holidays. If we had known that he didn't do the blood test then we would have gotten it done at my 12 week appointment at the other doctor. Now it's too late as it can only be done between weeks 10 and 14 apparently. I really don't know how the "miscommunication" even happened. We both remember the doctor telling us about the blood test you can get that tells you your risk of gene defects and me saying I wanted to get it done.

There is another blood test I could get but it costs between 300 and 500 euros as far as I know. It's called the Harmony test. They would send my blood off to a lab in the US apparently and it would take about a week. The results are about 98% accurate. I've read that there can be false negatives or positives though and sometimes the blood test can be inconclusive. We are undecided about whether to get it or not. On the one hand it would be nice to get the peace of mind that things are ok but I think the risk of something being wrong are still very low. The measurements taken at the last ultrasound were all fine. If there were some health problems with the baby then we would like to ideally know in advance and plan for it. If there is something seriously wrong then that would be a very difficult conversation since hubby and I have somewhat different views. But I would like to remain positive and have faith that everything will be ok. When we go for my appointment next week we'll discuss our risks with the doctor then.

Week 15 - later that week

Tomorrow is our appointment! I'm excited to see the baby again. And a little nervous too. I think the nerves will always be there a little bit. I've started coming down with a sore throat lately and just feel quite run down. My nausea was pretty bad last week, I had to throw up several times but it has been more bearable this week, or maybe I'm just managing it better. I wonder whether we'll be able to find out the sex tomorrow! I am convinced it is a girl so I'll be shocked if it turns out to be a boy. I just have a strong feeling for some reason. I've had dreams about having a little girl too. We decided we are going to get the harmony blood test done. We probably should have done it weeks ago. It would give us peace of mind to know that everything is ok. Well with 98/99% accuracy.

I'm starting to look a little more pregnant too! It's getting harder to "hide" it at work. I think I'll probably have to start telling colleagues soon. Hubby has been really great. We're married four years now and still as happy as ever. He's been protective of me and the baby which is really sweet. When I'm lying in bed and have heartburn he goes down to the kitchen to get my heartburn tablets or a glass of water. He often cleans the kitchen to help get rid of all the food smells so I feel less nauseous. I still can hardly believe we could have an actual baby next year! I was out with friends for lunch at the weekend and there was a tiny newborn baby at the table next to us. Very cute. I was thinking, "am I really going to get one of those?" So amazing! The only thing that scares me a little is the actual childbirth but I'm trying not to think about that too much yet. I'm not that anxious about the pain, although that doesn't sound fun, but rather scared of something going wrong. The hospitals and doctors here are really good though so I know I'll be in good hands. I'll just need to learn all the relevant words in German beforehand!

The immune doctor send me the printout of the test results from my blood test at week 13. She recommends I get another blood test done at week 17 to check the natural killer cells again. That seems excessive to me. Surely by now even if my natural killer cells were to increase my body wouldn't fight the baby?! I'm considering not doing another blood test but then I don't want to take any risks either just in case. I'm going to ask my doctor tomorrow what he thinks. We decided that we won't fly to Ireland again until after the baby is born. Or fly anywhere. Hubby worries about the baby being exposed to radiation. I know plenty of people fly all the time but if it makes him feel better for me not to fly I'm ok with that. Also the fact that the only time I had some bleeding in this pregnancy was a few days after my last flight to Ireland makes me worry a bit about it also. I do feel sad at not seeing friends and extended family again.

However my family are planning to visit me here which I'm excited about. And I'm planning to arrange some skype chats with friends so I can still catch up on their news. I recently found out another friend of mine here is pregnant too. She's two weeks behind me. It will be nice having someone at the same stage to meet up with. Some friends told me recently that they hated being pregnant. I guess they didn't like feeling sick and uncomfortable. I can honestly say I love it. The hardest parts are the anxiety and nausea. The latter I mentioned already, mine seems to be worse than average but it's still manageable. The anxiety is hard though. I'm often worried that something might be going wrong. Apart from that I love the idea of having my baby with me wherever I go and I don't want to rush this time away.

The Hebamme who was meant to visit me got lost and couldn't find her way to our house! She phoned several times and we gave her directions and in the end she gave up. That was rather disappointing. She said I can "call her when the baby is there". To be honest I would much prefer to meet the person before the birth. I messaged another two recommended Habamme and both were too busy to take anyone else on but I finally found someone and I'm going to meet her in October. Hopefully she's nice.

Week 16 appointment

We had our appointment at the doctor finally. The whole thing took ages. Every time I have to give a pee sample, get weighed and have my blood pressure checked. The latter of which was very low. That probably explains why I've noticed I feel dizzy if I stand up to fast. The doctor's assistant also used a device on my stomach to measure any contractions which took about 20 minutes. Luckily there weren't any as it would be far too early! She also gave us a free pregnancy box which contained a few things for the baby. You get another box after birth. We put it into the green room.

We agreed to do the Harmony blood test. There were three options. One that just checks for the three most serious potential issues. The second would have also told us gender and the third option would check for less serious issues (for instance turner's disease). We are happy to just wait until the gender is revealed at a scan and we just wanted to rule out the most serious and potentially life threatening issues so we went for the first option. We'll find the results out in a week. It doesn't actually get sent to the States, they now have labs in Germany where the harmony test can be done. It only cost 250€ in the end. Totally worth it if it gives us peace of mind.

The doctor wouldn't have done an ultrasound today but said he could get one for 40€ extra. Naturally we wanted to make sure everything is still ok with the baby and have a look. Actually this time the baby didn't look all that different from the previous one, and we couldn't really see so much extra but it was still lovely of course. As soon as the doctor started the ultrasound the baby was visible immediately and as usual I found myself holding my breath until I could see the little heart beating. That anxiety never leaves. At one stage the doctor zoomed in on the baby's genital area and said it looked like a girl most likely, although he commented that we shouldn't go out and buy loads of pink things just yet. However later on he was looking again and then he thought he did see something and was less sure! So in the end it was still inconclusive. That was a little disappointing, it would have been nice to know already. My next appointment won't be for five weeks which seems long but that's how they do it here.

There was one potentially bad thing though. The doctor noticed something when he was scanning me later. I'm not sure if he was looking at the placenta or what but then he said I could be at higher risk of developing pre eclampsia which is a little scary. He told me to buy a home blood pressure monitor and use it three times a day making a note of the values. If the value gets too high on a few occasions then make an appointment with him asap, not to wait the five weeks. He also told me to take drops for my blood pressure.

Hubby and I were a bit confused after since my blood pressure is more likely to be low rather than high. When I got the bottle of drops of which I'm meant to take 20 drops of a day, I noticed it has a high alcohol content! So then I was wondering what's worse for the baby; me having too low blood pressure or consuming small amounts of alcohol? I presume if my doctor says it's ok it is but I'm thinking of just taking 10 drops a day at first and seeing if that helps.

We also got another printout of the ultrasound. I took a picture with my phone and when I zoomed in I thought I could make out a cute little button nose and pretty lips! After everything went well with the appointment I decided to phone an aunt who hadn't heard the good news yet. She was delighted for us and I'm glad I told her myself. She also shared some stories of my Mum and Granny with me which was lovely (both of whom have sadly passed). She told me how wanted myself, my sister and brother were. It was lovely to hear. I know my Mum would have made a really fantastic grandmother. Whenever big events happen in my life, it reminds me again what a loss it is when you don't have your mother around. I have to believe she's in heaven watching down over us all now. I'm going to tell our child all about her of course!

I can more or less accept that I am pregnant now, although I still can't believe that we'll really (please God) have an actual baby with us next year! I feel grateful every day for this miracle and never take it for granted.

Thursday, September 7, 2017

The Handmaid's Tale #BookClub

Everyone seems to be talking about "The Handmaid's tale" recently. It was written in 1985 by Canadian author Margaret Atwood but has gained more fame recently after a tv series has come out based on the book. I was intrigued by the premise and happy when it was voted as our next novel in my book club.

I knew that there would be some infertility elements so I was prepared for that. The book is set in a dystopian society in the future. The majority of women are barren and infertile. It seems like a lot of the men are sterile but it is a male dominated sexist society so the male side isn't acknowledged openly. The women who ARE fertile are known as handmaidens and they are first trained and then sent to live with a couple in order to try to conceive a child with the husband which will then be raised by the man and wife. A few months after the birth, the handmaiden will be sent elsewhere and the cycle continues. It is a several tier society. Wives have more power than the handmaidens but not as much as the husbands. There are women called Marthas who are barren that work as housekeepers. There is a strong police presence and spies known as "Eyes". People who say or do the wrong thing get taken away and tortured or worse.

The book centers around the story of one handmaid, "Offred". That is the name that has been assigned to her. All part of losing individual identity. Initially she is a little like a zombie, just going along with the life she has now. Well, it's not like she has much choice in the matter! She often wonders about her ex boyfriend and child who were taken away from her. Without giving too much away, she gradually becomes aware of a secret resistance movement.The husband of the house she's living in also starts wanting to bend the rules with her. As does the wife. Both of which lead to her taking more and more risks.

In terms of the infertility element I found myself often feeling sorry for the wives who weren't able to have their desperately longed for child. It was awful how the handmaids were reduced to baby making machines, which just made me think of how ridiculous it is to base a woman's value on whether or not she can conceive. Women are so much more than that! The book was really good. Not like anything I'd read before. Once I got into it, I definitely wanted to find out what would happen next. I thought the ending a bit abrupt though, a lot is left open. The book has some disturbing scenes and the scary thing is that the world described doesn't seem all that far fetched at times. Let's hope it never becomes a reality!