Sunday, December 9, 2012

The One Where She Has Emergency D&C After Waiting to Avoid D&C

Well, that was fun.

Ready to hear the tale of how this latest pregnancy finally came to its miserable end, with a spectacular display of pain and suffering that only someone like me, with the worst reproductive luck in the history of humankind, could incur?

Well, gather 'round, friends. Pour yourself a glass of something good. I'm ready to tell it.

So last weekend I was nearing the end of my threshold of patience for "waiting it out." Although my history of uterine scarring (Asherman's) gave my doctor much understandable pause about doing a D&C, I was nearing ready to try Misoprostol, despite my own personal really bad luck with it (during the first of my five pregnancies -- the pre-H miscarriage following my first IVF attempt). Because let's be clear: Waiting to bleed out a dead fetus is most definitely not like "waiting for a period" as myriad health care providers will try to convince you it is. I was sick of feeling pregnant without the benefit of shopping for cute baby outfits. Call me vain, but I wanted the ability to fit in pants beyond my one pair of acceptable borderline fat jeans I keep around in case of emergency.

So I'd called my OB's office to give me the medication, and I'd decided last Monday would be the day I'd take it. The thing about a plan to take medication that makes you bleed your girl parts out is that you have to find a time in your schedule where it's convenient to sit on the toilet bleeding your girl parts out all day long. My husband agreed to stay home on Monday and watch H so I could do the deed.

Except last weekend I started spotting and then Monday morning I woke up with period-like bleeding. I felt very crampy on and off for most of the day. The cramps were quite heavy at times, and I can't say I was having a great time, but it all felt very manageable. Until it didn't.

I went upstairs to take a shower around 3:30. When I got out of the shower, I felt a gush of something and I feared looking down, but I really didn't see anything. I thought it was kind of weird but there's plenty of weirdness going on when you're passing a pregnancy so I didn't dwell on it. I went back downstairs to my perch on the couch to watch a Christmas special where Giada and a house designer remake someone's house and then teach them how to cook. I was silently cursing Giada for being so adorable and yet so hatefully, enviably skinny, when I felt another gush.

I ran upstairs.

It was blood. So, so much blood. So much blood I don't even know how to describe it here.

You know how they tell you that you will know you're bleeding too much when you soak more than a pad an hour for three hours? I would like to know right now who the hell came up with that ridiculous measurement. Because when you're bleeding too much, it cannot be contained by a pad, your underwear, your pants or the seat beneath you. It gushes out of you in a way that actually feels uncomfortable coming out of you. It feels like it must be stopped. Right now.

I ran outside, where my husband was playing with H. I told him I needed to go to the hospital. He heard me, but he is a man, so he thought I was telling him I was going to the hospital, like "Ta ta! I'm off to the hospital!" You'd think after all we've been through he would know better. I told him he would be driving me, thank you, as I was not interested in blacking out behind the wheel if it came to that. Except I was really upset, so I'm not sure it sounded calm and reasonable, or even like English. But he got the message and ran to the car with H.

When I got out of the car at the ER door, I felt more gushing. I literally waddled into the door, where I was greeted by three women, thank God. I sat down and promptly bled all over their triage chair. I really didn't need to say anything, but I told them I was likely hemmorhaging and needed urgent medical care. And I got it. They wheeled me directly back. Apparently bleeding is one of those things that gets you a ticket out of a two-hour wait in the ER, in case you're ever wondering.

Also, if you're ever looking for a good time, or to test your ability to think swear words urgently but not scream them out loud, I highly recommend a pelvic exam during a miscarriage at the exact same time that they're trying to jam an IV into your arm. The good thing is, you're not sure where to direct your discomfort sensors. Is the feeling of having blood clots grabbed out of your lady bits more or less comfortable than a tube entering your vein? The jury is out, my friends.

After some waiting, I was then wheeled to an ultrasound with the Worst Ultrasound Tech in the History of Infertility and Pregnancy Care. I won't trouble you with the details except to say that she was slower than slow except when she needed to tell me something urgent like, "You have lots of fibroids!" or "Wow, you are bleeding a lot!!!!!"

Finally, I was wheeled back to my little ER room, H having been released to a very kind friend willing to come and get him and take care of him for the rest of the night. The ER doctor came in and told me -- newsflash -- that I needed a D&C. She said there was a good amount of tissue remaining and I'd probably just keep bleeding as I was until it was out. She said the OB (a partner of my own, who was not the one on call) was on his way in and he'd come and discuss it with me when he arrived.

Meanwhile, my one stroke of luck sauntered in: the best anesthesiologist on the planet. Not only had she gone through four D&Cs herself, but she actually said the words, "You tell me what you want for anesthesia." You know, I can't believe it's true that it's actually hard to find a doctor who is willing to be kind to you when you're going through something like a miscarriage, but it is. This doctor, thankfully, was one of them. I knew the D&C was going to suck, but I knew it would suck less with her near my head during the procedure.

Then, the OB walked in. With some hindsight, I think I understand why the conversation didn't go well. I think he thought he came all the way in to the hospital during his call to meet a patient who had presented with severe bleeding and that he would be hailed as a hero. Instead, he got a patient who was informed, hesitant and full of questions. Who dared suggest that he talk to her RE about her Asherman's case. Who asked questions about the way he would conduct the procedure. He didn't like it very much. He asked if my RE was the only one who could touch my uterus, why wasn't she on call 24 hours a day for me in case of this situation? He questioned the wisdom of waiting in light of the outcome. He was defensive and sort of generally not very nice to me, and since I was already fragile I broke down in tears immediately. I simply could not believe that I was in this situation, about to get the D&C I walked around with a dead fetus in me for three weeks to avoid, in a new care setting (because it felt like an emergency I went to the hospital near my new town, which is my OB's hospital but not my RE's), with a doctor who was not only new to me but who obviously hated me too.

Both of us sort of backed off after I started crying. I just sort of recognized the obvious, that I was in no shape to get up and go to a different hospital or wait for my RE to be available the next day, that I needed a D&C now and despite the doctor's attitude he seemed skilled (naturally I'd looked up his bio when I learned his name) and aware of the need to not go crazy with the scraping. I'd said my piece, he was aware of my concerns and I just needed to let him do his job. And I think he recognized he'd been overly defensive.

And so they wheeled me into the OR and I had the surgery. I was awake the entire time, with little more anesthesia than IV narcotic. I heard the tissue get sucked out of me. The whole time I was just thinking,

I never want to be here again. I don't give a crap about another kid. Just get me home in one piece to the one I have.

Recovery was quick. As I stood up from the wheelchair and got in the passenger side of my car, the fresh air against my cheeks brought me back to life. The streetlights had that muted glow of early winter and I had that sense of gratitude you have after being really afraid of something and then realizing everything was going to be okay.

I don't know where we go from here. I don't know why I have to be having another freak show nightmare miscarriage in the middle of Christmas. I don't know why this all has to be so hard.

All I know is, thank goodness it is Christmas, actually, because what would I do if it were just the dead of winter with the ice and the slush and without 10,000 sparkling lights all over the bushes outside my window? What would I do if I couldn't take this all away just by thinking about a boy upstairs right now who believes in Santa Claus with all his heart? A boy who reminds me what is possible if you just keep on pushing through all the pain, if you're crazy enough to keep trying even when a voice inside you says it may be time to stop?

Sunday, November 25, 2012

The Invitation

I just declined a baby shower invitation. I got it a couple of weeks ago, right after I found out. I wasn't surprised at all when I found it in the mailbox, both because I was expecting it and because I've come to expect that the universe thinks it's funny to mess with me.

This shower is for a former co-worker, the loveliest girl you'd ever hope to meet. This is her first baby. She was the only person at work who knew I was going through infertility when I was going through IVF for H. She gave me an ear when I was desperate for one during the work day and, although she wasn't married at the time or remotely in the realm of babymaking, she was sympathetic and thoughtful. But the shower is next Saturday, I'm still walking around with a dead fetus in me and it just feels ill-advised to go. I just keep thinking of the advice we received in my mind-body program for infertility, to look at times like this with an eye toward self-protection. We got permission to say no to events like baby showers, without guilt.

So then why do I feel like such an asshole?

This feels just like the time when I said no to a college girlfriend's baby shower, when I'd just found out about my pregnancy with H -- I was pregnant, for crying out loud, with a good pregnancy -- and everything felt so tenuous and fragile, and I was still terrified. I just couldn't handle sitting there looking at baby stuff when it was so uncertain whether it would be mine too, in nine months or ever. And as soon as I hit send on the decline, I felt selfish, like a miserable person whose happiness for friends was contingent on her own fortune, an even fertility score.

What, exactly, am I so afraid of? I am not prone to public meltdowns. I'm pretty sure I can avoid a Kristen Wiig/Bridesmaids moment and restrain myself from knocking over the chocolate fondue fountain or attacking the giant cookie during the event. I'm already miserable, so even if I cried in the car all the way home, it really wouldn't be much different from what I'm doing now.

I definitely wouldn't attack the cookie. I could be gracious. I can be happy for others. I am. But I just couldn't bring myself to go and sit and look at the onesies. I couldn't say yes.

Thursday, November 15, 2012

Mean Old Man

Today was find-dead-fetus-on-ultrasound day. What to wear, what to wear when going for dead fetus ultrasound...I settled on J. Crew corduroys in charcoal, a Splendid ruffled knit cardigan, teal beaded necklace and fuschia smoking-slipper loafers. I put on cover-up, lip gloss and mascara. Because grief doesn't have to be ugly, people.

Do I need to state that walking into the hospital, I felt bitter and angry? Like a teenager forced into some outing with her mother, I really wanted to turn around and run. Where would I have gone? Probably shopping, though there was a not insignificant piece of me that wanted to go put on heavy eyeliner and smoke cloves where I might get caught.

But I pressed on. And even though I felt angry enough to keep tears at bay, turns out they were right on the surface. A group of developmentally challenged people were walking, accompanied, into the hospital in front of us, and seeing them just nudged those tears right out. I just thought, Life is hard. And sometimes so sad. And so, so unfair.

I made it to the women's imaging center, and that's when I felt angry again and became that old guy. You know that old hospital patient who won't cooperate, who barks orders at everyone, who refuses to put in his dentures or tie up his johnny? I was that guy today. I told the front desk staff I wasn't going to be participating in their go-change-unnecessarily-into-a-johnny-and-wait-by-yourself-with-roundly-pregnant-women charade -- I would be staying in the waiting room with my husband, thank you. I also informed them that their clever system of making you check boxes on a form as to whether you were going to somehow fall in the process of getting an ultrasound, along with a bright yellow slip of paper reading "FETAL" was an abject failure, since in reality no one ever collects those pieces of paper and you end up finding them in the bottom of your bag every time you get home. I just dared anyone to push back, lest I tell them all about my being there to find a dead fetus.

Then, when the ultrasound lady asked me if I would mind if a student came in the room, I told her yes, in fact I would mind, I was there to confirm a miscarriage and I wasn't in the mood. I then refused to let her do an abdominal ultrasound, telling her that I pay a steep co-pay for everything they do, and since they weren't going to confirm anything abdominally anyway, I would not be having that one, thank you for offering, since I would rather spend that money toward the designer handbag I so deserve to buy myself right this very minute. Incredibly, she asked the radiologist and they agreed. I think by the time the radiologist entered the room, he was slightly afraid of me.

They did the scan and the radiologist came over to me, and I think he thought he was breaking news to me, because he said in a very measured voice that he was very sorry but what they thought was happening happened, that the heart stopped beating and in fact the fetus had already started breaking down and was not terribly measurable. He went on to describe that a fetus that has died sort of becomes more like a cyst in your body with some sort of fluid process, all of which I could have done without knowing. But then he said they would go as fast as possible for the rest of the ultrasound and take limited pictures so I could get out of there ASAP. Spoken like someone who's maybe had a loved one on the wrong end of an ultrasound.

I went up to see my doctor. She asked me if I'd given more thought to resolution, again pushing me more toward trying to wait it out rather than risk the implications of more uterine scarring. She then handed me one of those "hats" they have in the hospital, the plastic things they put on the toilet to catch and measure pee. I'd asked for it, but the fact that it was on her table in something that could have been a gift bag struck me as both hilarious and grotesque. Anyway, if I'm going to have to catch this thing at home for testing, I'm going to need a bigger container than they originally gave me, because I'm definitely not fishing around in the toilet for it.

So I agreed to wait, but I told her I didn't think I had more than another week in me. She encouraged me to try to forget about it now, now that we know for sure it's really gone. To just let go, have some wine, go out and do something fun. I think I may have given her a bit of a hard time today too. I was sort of not at the stage where I could be totally pleasant to make everyone else feel better. Because something really unpleasant is happening to me right now, and drinking wine and going out for dinner won't make that go away. Maybe I was a bit immature today. But pushing back a little made me feel more like a force of nature than something nature is having her own miserable way with.

Tuesday, November 13, 2012

Ignorance and Bliss?

There's a mom of one of H's preschool classmates (more on preschool at a later, more clear-headed time) that found my last nerve the first day I met her by asking two questions: Was H my only child, and did I have plans to have more? Little did she know she bought two passes to the lion's den by raising the topic. I polititely danced around the latter question, still having the I-just-met-you-and-will-give-you-a-pass generosity of spirit. When she asked me for the third or fourth time on the playground one day, I was much more firm. I told her it was a very complex and difficult topic and I really didn't want to get into it.

That silenced her for the time being. But several weeks ago I bumped into her again on the playground and she took the first opportunity -- any opening that might somehow relate in the most general sense -- to non sequitur her way to an announcement of her pregnancy. Clearly, her earlier questions were simply a proxy for her discussion of her own situation and family plans, had I the politesse to ask her back (which I did not). What came out of her mouth next, though, mesmerized me for a full minute: She was telling me, a virtual stranger, that she was eight weeks pregnant. She added that she hadn't had an ultrasound yet. What.

The fact that I myself had just learned I was pregnant and thought there might be a chance it could actually work did little to quell my irritation or wonder at her hubris. Frankly, from an empirical standpoint I was fascinated. I sort of wanted to take notes for some sort of yet-to-be-determined anthropological study. Naturally, I was 100% certain that her hubris would be rewarded with an uneventful pregnancy.

Now, sitting here losing my own, I'm not so sure where I stand on it. Part of me wishes I'd had even one more day of ignorance about this doomed fetus. One more day of letting my mind inch toward an optimistic thought here and there, allowing it to round the corner and peek quickly at the possibility of a frilly girl's nursery or H sitting with his brother. One more day of maybe.

But would I really want to walk around not knowing that the baby I pictured was actually a fading fetus? Isn't it better somehow to know? I'm not sure. I worked hard to protect myself this time by really staying detached, at times almost eerily so, and I just don't know that it impacted my grief one way or another.

I do know that the experience of suffering on my way to motherhood has made me a better mother in all kinds of intangible ways. I love that kid fiercely. I'm bonded to him, the way you're bonded to someone you've fought for.

Still, I think I wouldn't mind a little ignorance and hubris now.

Sunday, November 11, 2012

Due Date

Today is 11/11/12, the day I'm grieving the loss of another much-wanted pregnancy, the loss of a promise I had -- and part of me believed in -- for just a moment, of holding my warm, sweet-smelling baby next summer. It also happens to be the due date of my last loss, the other seemingly healthy pregnancy I said goodbye to earlier this year. And it's the one-year anniversary, almost to the day, of when the betas went south and I took a shot of chemotherapy drug to end my first, surprise natural pregnancy. I'm on a continuing loop of loss, milestones of these shadow pregnancies building up and overlapping, marking the calendar with sad observances for which there is no adequate ceremony.

Today, I could have been in a hospital room. I could have gone in early this morning, dawn barely breaking in the ashen sky, shaking and chilly from nerves but also from the intensity of the moment, the moment right before you meet the baby whose outline you saw in your mind's eye, even as all the heartbreak whispered to you to give up, walk away, cut your losses, move on. The baby you believed in. I could have been told to change into a gown while my husband went to another room to put on surgical scrubs, an absurd costume for an otherwise tough guy who becomes queasy at the sight of blood. I could have giggled slightly at this irony, but also prayed earnestly that he not pass out in the OR. I could have walked into the OR, once again struck by the surreal sterility of the room where, in just a few short moments, all the drama would unfold. I could have had a spinal, and then the opportunity to remain more calm this time, be more present when my baby emerged. A nurse could have walked over with my baby, pure joy and love in eight pounds, and I could have marveled at how much s/he looked just like H.

I could have been brought to recovery and held my baby on my chest, all that bliss flooding back to me as if no time had passed at all since I held my sweet little H, making me love him even more even as my heart made room for his sibling. I could have felt once again like I'd unlocked the secret of the universe, shaking my head and wondering how I could be so lucky. And all the pain I'd endured with the loss before this pregnancy, every hard step toward motherhood could have melted away.

I could have had this, and to me it would have been miraculous, but the truth is it wouldn't have been out of the ordinary. Because today, in hospitals all across the world, this is unfolding for mothers new and experienced, those who had to work at it but also those who have known no pain in their quest toward motherhood. And it would have done the universe no harm -- no one else would have had to suffer anything for it -- if it had just let me be one of them.

But no. Today, I sit in front of my computer, wrecked, trying to keep my mind away from my abdomen, where another fetus lay either dead or dying. Waiting to see how it will come out of me. Wondering whether there is any way to stop this loop of loss, whether we can change the course of a future pregnancy toward the above outcome, instead of arriving in this sad place again and again and again. Wondering if a due date will ever again bring the arrival of a baby to fill it up.

Saturday, November 10, 2012

Beauty Tip for the Bereft

I hope this never happens to you. But if, like me, you one day find yourself grieving a dying fetus, you may look in the mirror and realize you look like Night of the Living Dead. And you may realize this is not a good look for you, and though you may not care a whit within the confines of your four walls, when you decide to venture outdoors in hopes of feeling half alive, you may not wish to frighten small children.

So you may wonder: What beauty product is designed to help you look half alive after you've had a miscarriage? They do not have signs for this at Sephora. So I will tell you what the answer is. NARS lipstick in Dolce Vita. I hope you never need this beauty tip, but in case of emergency, please break glass. You're welcome.

Friday, November 9, 2012

The Aftermath

The worst part of finding out that the fetus inside you is dying is knowing that the fetus inside you is dying while you're carrying on. Your mind goes all kinds of dark places you wish it could never find. Like, Is it happening now? Does it feel anything? When will my body realize it's dead?

Also, you still feel pregnant. I'm still hungry, ravenously, insatiably hungry, yet having to eat like a pregnant person now disgusts me. This morning I saw that my boobs still think I'm pregnant too -- they're still killing me and ballooned up, apparently gearing up to nurse a baby that will never exist. I actually swore at them, dropped an f-bomb at my own body parts, I was so angry at them. My body hasn't gotten the memo yet, and it feels like another betrayal.

I forced myself to take H out this morning. I knew it was my duty to do so, but I'm not sure it did me any good. I saw pregnant people everywhere, and I hated them all. And then I loathed myself for it.

This could have been it. I could have been done. Once again, I was so close, it was so within reach I could taste it. Now I have two choices: Subject myself to more pain and heartbreak or walk away from my heart's true desire -- not only for me, but for H, who deserves a sibling. The latter still, incredibly, doesn't feel like the right answer. But I'm brittle, and I don't know when I'll break.

Thursday, November 8, 2012

Groundhog Day

A few days after my last post, at the end of my cycle and still not bleeding, I decided to take a pregnancy test, frankly because I was 100% sure it was not positive and wanted to self-medicate with chocolate, caffeine and possibly copious amounts of alcohol. Except it wasn't not positive. It was positive. Maybe. Very, very faint. So I sprang for a FRER to see if I could get a more definitive answer. It was definitive.

My hcg the next day was 42. I think I know everything now, so I thought that was bad, but my doctor said no, this was a natural pregnancy, we have no idea when we're catching it, it's fine. So for the past few weeks I've watched yet another pregnancy unfold that has seemed perfectly healthy. Betas more than doubling. An intrauterine pregnancy at last Thursday's ultrasound, albeit an early one with a just-started-beating heart rate. Everyone had a good feeling about this one.

I didn't write about it here (or talk about it with friends IRL) for two reasons. One, because I was doing everything in my power to ignore it. I just refused to get attached to the idea this time. And maybe along with that, I was hoping if I didn't talk about it, avoided black cats and only opened umbrellas outside, I might be spared further agony. Also? I just didn't want to bring everyone along for the roller coaster ride. I just thought, maybe if I don't talk about it even I can stay off the ride. I can just coast, somehow stay above the fray.

Anyway. This morning was Groundhog Day. Another ultrasound, a bundle of nerves walking in, stripping, leaving my dignity at the door and laying on the table, bracing myself for the answer to all my wondering about the fate of this pregnancy. News came quickly. Growth was three days shy and the heartbeat is decreasing. Another bad ultrasound, another public breakdown, crying openly as I walked from imaging to my doctor's office. Another day ruined by shitty reproductive luck.

As usual, this isn't the end of the shittiness. Once we confirm the heart has stopped beating through a follow-up ultrasound next week, I have two choices. I can opt for a D&C, in which case we may get more answers but possibly also more uterine scarring, which could be bad enough to further impede my efforts -- there's just no way to know. Or I can take the whole "expectant management" route, in which case they've encouraged me to try to capture the tissue in a small jar with saline solution that they then expect me to keep in my refrigerator until I can get it to the hospital. I told them this is fine if they also want to send an ambulance to take me to McLean's, because that could be the thing that finally sends me over the edge.

What else is there to say? There is nothing to say. There is nothing that won't make me feel grief, or worse, pitiable. I don't want to be pitiable. I have a beautiful son, who missed me like crazy while he was in school and I was at this horrible appointment finding out about his ill-fated sibling. He ran up to me, jumped in my arms and told me he missed me, chin quivering, choking back tears. I fought them back with him.

Wednesday, October 10, 2012

Stranger in a Strange Land

Boy am I glad I'm back on here, because this story needs to be told, if only for my own sanity's sake.

Went to a play date this morning with H, with some newer friends we're getting to know in our still-new town. Let me start by saying for the record that in general I think these moms are very nice ladies who I like generally, and even the silliness I'm about to get into doesn't mean I don't like them. And yes, the Sunday School part of me feels guilty for what I'm about to say about them behind their back. Second, let me state that even though I knew there would be lots of new babies at this play date, I promise you that I went in with a perfectly happy attitude. It really didn't bother me or make me moody at all.

Things were going fine until the first warning sign: a highly casual, breezy conversation between the two women who just had babies four months ago about their plans to have yet another, and when they'll be pulling the goalie (my term, not theirs, though they may as well have used it). But of course no one will ever even think to call them greedy.

Then one of these same moms made a comment about how she won't be giving this baby rice cereal because of all the arsenic. I'm sure it makes me naive/ignorant/a bad mom that my first thought was, for Lord's sake, why don't you just put the kid in a bubble suit and be done with it. But my peevishness around her innocent comment sent off a warning flag: I could see that now that she'd revealed herself a smug fertile, everything she said was going to irritate me.

But the piece de resistance came when the other newborn mom started in about her recent delivery. Now we're coming up on the due date of the second pregnancy I've lost, so really, I don't want to hear about your delivery story at all. But what I really don't want to hear? Is that you were annoyed that the medical professionals involved in your birth were telling you what to do.

She was complaining that, because it was a VBAC, they were being all mean, telling her she needed to be -- horror of horrors -- monitored and all that silly stuff. That that meant she couldn't be all up and walking around, or getting in the tub. She said she finally said that if she couldn't get in the tub she was walking out of the hospital.

I just don't get these women. I mean, if that's your attitude, why even bother going to a hospital? Why not go squat in a field?

Oh, the hubris.

When someone made a comment about liking a certain local OB-GYN practice because they'd let you do whatever you want, I couldn't hold back any longer. I said, See and I don't want them to let me do what I want. I don't want to have an opinion. I want them to tell me what modern medicine says is going to keep my baby alive.

To which the other mom replied that yes, absolutely she agreed, she only wanted all those things because she felt it was best for the baby. Because her body was telling her everything was fine.

Her body was telling her.

Here's where my mind went. I thought of all my ladies who have done everything right and still have gone through hell in one form or another. I thought of how we can never take a single step toward a take-home baby for granted. I realized that having a baby isn't an equalizer between the fertiles and those of us who've had to pay more dues -- and even two "natural" pregnancies hasn't made me feel any more like one of them. That I can never be in a room with this kind of conversation and feel like anything but a stranger in a strange land.

Although I wouldn't mind a little take-my-fertility-for-granted in my life, the fact of the matter is, I would never want to be on the side of things where you think you know more about childbirth than people who go to medical school. Do these women tell pilots how to fly their plane? It was a very silly conversation and it made me feel lucky to have friends, both here and IRL, who, like me, tell their doctors that the only birth plan they're interested in is "let the doctor get the baby out in one piece."

Thursday, October 4, 2012

Achy Breaky, Part II

Next up in my sad country ballad year: my rebound pregnancy, done gone.

After finally getting a zero beta from the phantom pregnancy that wouldn't quit, I felt refreshed. Like I'd been in the ring with a formidable opponent, and during a timeout had figured out the winning strategy I needed when I got back in. I was ready to try again, and even though I recognized the slight insanity of asking to do it all over again, I'd gotten a taste of what was possible and I wanted more.

When I got my two lines this time, I sort of just nodded my head. It was kind of a perpetual motion thing, an inevitable outcome, like yes, of course, Pregnancy tests are turning positive all over these days! Also my jeans had been unusually tight for a few days; either I was pregnant or I'd been overindulging in cheese and chocolate. It did cross my mind that maybe the hcg was leftover from the last one, maybe it had lingered there or perhaps spontaneously generated from some sort of bad-pregnancy sleeper cell hiding out in my uterus. My nurses assured me that was nuts, a thought only a scarred infertile girl would have (they said this all in the nicest of ways), and an initial level of 212 that more than doubled in 48 hours backed me off that ledge to accept the dumb luck of a back-to-back pregnancy. I didn't quite know how or why it had happened to me, finally, after everything I'd been through, but I embraced being a fertile myrtle. I am sorry to say that I broke out my baby name book.

I sat waiting for my first ultrasound in a room divided into two types: middle-aged women dutifully awaiting their annual mammograms and roundly pregnant 30-somethings looking bored, checking their watches, clearly stressing not over whether their babies were on their way to full-term status but whether they'd be out of there in time to...I don't know, make it back to work? Catch Ellen on TV? It was baffling to me how a pregnant person could sit there thinking of anything else but whether the ultrasound would make or ruin her day/year/life. Because that, my friends, is what infertility and pregnancy loss will do to a girl. I sat there in my blue-patterned doubled gown looking down at my flats, moving my legs in a desperate attempt to dispel the kinetic energy building in my body. I willed away preemptive tears, welling up repeatedly anyway.

Funny thing was, despite this Pavlovian anxiety response to being in that waiting room, I knew everything would look fine that day, that we'd see a heartbeat, that this pregnancy would look good. The hcg numbers looked too good and I felt pregnant. Which I know is a bunch of unscientific baloney, it sounds like reinventing history, like when women respond to online surveys saying they "just knew" the moment they got pregnant. But at the time it seemed significant.

It took all of three seconds for the ultrasound lady to confirm my suspicion, when that beautiful flicker suddenly flashed on the screen. If I never get another chance to be pregnant again, I'll hold on to this moment, when everything that seems significant in your life boils down to that 120 BPM rhythmic thump-thumping you can't stop watching. This was real. This was mine. This was happening. My cup runneth over.

My cautious glee was short lived: I measured a few days behind where I thought I should be. Cue the ominous music. I went upstairs to see my doctor, certain she'd say something cautious about being spectators on this one. She didn't. She swore up and down that it was fine, that because this was a natural conception my guesses were just that. She talked about where I'd deliver the baby. She made it feel real again.

And it kept feeling real until one afternoon, while H was napping, when I lay on the couch feeling not quite right, then got up and felt the gush. I thought, no way.

Not now.

Please no.

When I saw it, I got angry. I watched myself from above, another personal tragedy unfolding, and what will become of our heroine this time? Will she survive another loss or is this the one that does her in? I seethed expletives. I called the doctor.

My OB's office was less than sympathetic, and this was the beginning of the end of my relationship with them. They told me, clinically, to just come in the next morning, since as I was aware, there was little they could do for me that day anyway.

I did what I was told, because I knew she was right, and pretending that rushing in that afternoon would change anything about the outcome just seemed sad to me. So I spent the rest of that afternoon and night monitoring the amounts of blood coming from me. It seemed to be lightening, which felt encouraging. Maybe it could possibly be like the early bleeding I had with H. Maybe I was just a bleeder. Yeah.

At the ultrasound the next morning, I hid my face in my hands. I thought about what it would be like to see a dark screen, no flicker. I thought, there should be some ceremony when that happens, they should put a cover down over the screen and say a prayer. But there was a flicker. It felt like a miracle. They sent me on my way.

The next day was relatively uneventful. The bleeding continued, spotting on and off. I spoke with my doctor. She was reassuring. I felt optimistic.

The next day, Saturday, started about the same. But by mid-morning, the bleeding was gaining momentum. There was force behind it. It felt more like an event. By afternoon there was no mistaking what was happening. I pitied myself. And then I was scared. You know, they expect us to manage ourselves, we strivers for and losers of babies. They want us to inject medications. We have to know what questions to ask. We have to school up on hcg beta levels and embryo quality and ovulation induction. But at some point, how can we judge the line between "normal miscarriage bleeding" and "needs urgent D&C" with accuracy? You tell me, doctor.

So we schleped our two-year-old son to the emergency room, where we sat for hours and tried to keep him from touching everything. Where we tried to keep him happy and act like everything was normal. "Pay no attention to that sobbing griever in the corner. Look over here!" He was in the room, although on the other side of a curtain, when the radiologist confirmed that it was gone.

I'd believed in this one. I thought, when I miscarry, there are signs. My hcg is off. There's no heartbeat right away. I thought that's how my story went. We had a heartbeat.

Sometimes, six months later, it still catches in my throat, the grief, a terrible thought. The other day, as I drove H to a play date, this one: A heart stopped beating inside of me. It lingered for a while, then faded away. I looked back at H and smiled bravely.

Wednesday, September 26, 2012

My Achy Breaky Heart, Part I

I've started this post about three hundred times over the past year. What stopped me from posting every time? I guess I'll call it writer's inertia. Usually when I write, I know generally what message I'm trying to get across, what the upshot is, the vibe. I know if I'm still in hell about something, or a silver lining is in view. I know what the message is, even if I don't yet know the precise words that will come out to give it shape as I start typing.

This time I didn't. I just didn't know what it all meant, what was happening to me, how to make sense of it, how to find a meaning deep enough to talk about here in a coherent way. And the fact that I couldn't find that meaning, that I didn't even have a thought I could marinate over through this forum -- it was demoralizing. I felt unmoored. So I didn't write. And not writing for a week turned into not writing for a year. I took an unintended sabbatical from the blogosphere.

It's taken me that year of sorting it all through to realize that I precisely missed the point of it all. That so many times before, even if I came to a post with one message, something unexpected was revealed that crystallized something, helped me cope, made something good even better. I never claimed to have all the answers, and that's what made blogging, being a part of this community, so valuable. And never before have I needed this community more than over the past year. Never before than now, as I continue to wade through it all. So rather than wait any longer, let me bring you up to speed.

What happened over this past year sounds like a country song. And not one of the perky, Tim McGraw style, apple pie songs that make you want to run in a field beside a tractor wearing gingham and overalls, arms outstretched, face to the sky. No. The I-lost-my-dog, I-lost-my-house variety. Here's how mine went:

I moved to the exurbs. My kid broke his leg. I got pregnant. Lost it. My cat died. I got pregnant again. And I lost that one too.

That's the abridged version, the chorus. Let me dive in more deeply. This may take a few posts.

I'll start with the first pregnancy.

Shortly after moving into our new house (We finally settled on one in a postcard-quaint, pastoral New England town, the kind with two private schools, rolling hills and strict limits on commercial building. I am now questioning the wisdom of this decision -- another post for another time.), I had to take H in for a follow-up on his broken leg (yet another later post), and had also arranged a follow-up appointment for my own foot, which is STILL broken today. I knew I'd be x-rayed, so as has become my custom, I took a pregnancy test, since I've long suspected that if I ever were to have a miracle natural conception, it would naturally occur on the month I had an x-ray so I could add "radiation exposure" to my long list of neuroses while pregnant. So I peed on a stick, put it on the bathroom sink and went about my business. Before leaving the bathroom, I breezed by the stick to locate the single line. Instead, I saw two: a dark line and beside it, an incredibly faint second line. I mean, the second line was faint. But I've done this enough to know that no matter how much you yearn for that second line from the seat of your very soul, unless you're knocked up, you just aren't going to see anything in that marshmallow white window. There's no such thing as a little bit pregnant.

It would have been the shock of my life if I'd allowed myself to believe it. But naturally, I had to attribute it to a faulty test in order to save face; it felt absurdly naive of me, given everything I've been through, to grant any stock to this. But somewhere in me there was a grain of belief, because I didn't have the x-ray. I told myself I'd test again in the morning, and if it too looked remotely positive I'd call my RE's office. It was, so I did. My hcg was 91 that day.

The crazy thing was, although I honestly couldn't wrap my head around being pregnant without a single medical professional's involvement, there was a part of me that felt like it was totally normal, even inevitable. Maybe it was the familiarity, of having been pregnant before, knowing my body actually could handle it. Maybe I just welcomed, for once, having something go right reproductively. I was nervous, yes, in all the ways you are when you've paid your dues in the reproductive department: You don't take a thing for granted. But I also felt acceptance of it, like I'd won a sweepstakes and opened my door wide for the people with the balloons and giant cardboard check.

Naturally, these feelings, this sign of finally, finally being capable of a semi-well-adjusted pregnancy, was short lived. The next day, I came home from errands and discovered blood.

Let me cut to the chase. This pregnancy ended in a spectacularly miserable way. We watched my hcg after the bleeding, and it did the whole just-under-the-range-of-normal increases, just to torture. We then did serial ultrasounds once it reached the right level, and naturally they couldn't see a damn thing, anywhere. So what happens with that combination of events is, they start talking ectopic. And you end up with an in-office uterine biopsy with nary a bullet to bite on while listening to them whisper things like "laparoscopy,""tubal rupture" and "methotrexate." When the biopsy comes back showing no fetal cells in the uterus but your hcg still climbs, you ask for one last ultrasound before they terminate your pregnancy in what feels like a still-voluntary manner. And when the radiologist tells you she can't see a pregnancy anywhere yet, and if the pregnancy is growing outside of the uterus it could be almost anywhere in your abdomen, you agree to take the shot of chemotherapy to end the ordeal.

It took two shots of methotrexate to end this one, because I'm me and it couldn't be "easy," ending with the single shot. And this drug made me sick -- sick, sick, sick. I was lethargic, frail, a shadow of my full self. I lost weight. I willed it all to just go away. It took from November until February for it to resolve, for me to feel whole again.

Because we knew almost from the beginning that this one wasn't going to take, it was a lot like my first miscarriage in that I could put it together in my head in a way that made it not so achingly sad. This was never going to be a viable pregnancy. It wasn't my baby. But what kept creeping in and casting doubt was the possibility that the doctors were wrong. After all, we hadn't seen actually anything growing in the wrong place, because enough evidence was there that they didn't want to wait that long. But what bothered me most was that it still felt voluntary. It felt like taking door number one -- the 100% assurance that my tube wouldn't burst at 2 a.m. -- when waiting around for door number three might still hold a miracle happy ending. As I type this, I realize there's no way that could have been true. But at the time it felt like voluntary pregnancy termination. And the ironic pain of that, combined with the effects of the medication was palpable: I felt the sadness right in my bones.

Still, as I recovered and felt like myself again and looked forward to a new cycle knowing, incongruously, that I actually was physically capable of becoming pregnant simply through the meeting of sperm and egg, I felt, improbably, hope. And that hope and faith were rewarded when, literally two weeks after I got a zero beta, I got pregnant again.

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