Wednesday, January 21, 2015

the aftermath.

By the time I got to the doctor's office on Monday, the bleeding had slowed considerably. It was maybe a light period (if that). We sat in the waiting room almost 25 minutes before being called back. I had an insulated lunch sack with two flat ice things and my glass dish. This I happily handed over to the assistant as I told her how upset I was with Dr. Smiles for not preparing me. She's normally one of the front-desk people but I guess they'd been slammed that day so she was helping out. We turned the dish over to the nurses and I felt lighter instantly.

"Do you want your husband to come with you?" the assistant asked. I told her no, that I didn't want to put him through this. He was in the waiting room with the BFF; that's where I wanted him to stay.

There's only one ultrasound tech (that I know of) at Posh Clinic. So the woman who first showed me Nugget's heartbeat was the same one to confirm that yes, I passed her that morning. There was still a small clot that I'd be passing but most of it was gone. There was no need for the D&E.

"Looks like you saved yourself a procedure," the tech said.

I'd hear variations of that phrase half a dozen times that morning, and all of them made me feel angry and upset. I DIDN'T WANT THIS. This is the only thing that kept running through my mind. I DIDN'T WANT THIS.

I got dressed and went back to the small waiting room until it was time to see Dr. Smiles. For this, I did call Mr. Hope back. We sat together, holding hands, until a nurse took us to see the doctor.

I'm pretty sure one of the first things I said to him was, "Why didn't you prepare me for this?" Only, in his mind, he had. He said, "I told you there would be bleeding and that there was a 50% chance you'd miscarry at home." Both Mr. Hope and I assured him that no, he didn't. We kind of argued over it for a couple of minutes but I was tired. I didn't have a lot of fight left in me. And when Dr. Smiles confessed that he'd just gone through the same exact thing with his wife not even three months ago - and that he was with her when she miscarried their nine-week fetus into the toilet - my heart broke that much more.

Dr. Smiles had told me that in the long run this was better for me. "Better for you," I'd said. But he insisted that the best procedure was the one I didn't need to have. Even though the D&E was perfectly safe, there's always a possibility of scarring or infection and now I'd have neither of those.

And even then, my head was clear enough to see that I'd been relatively lucky. Emotionally, the whole thing was appalling and traumatic. But physically, I'd just had some really bad cramps. Hell, I think I slept through the worst of it. You read stories of women who have actual contractions during a miscarriage. Not to be crass, but all I had to do was fart.

I mentioned to Dr. Smiles that I hadn't heard back from the UnproRepro about our next match. He asked if we wanted to be proactive and talk to her while we were there. Mr. Hope and I looked at each other. Typically he doesn't come to my appointments - at least, he hadn't until there were ultrasounds - so we figured what the hell. We were both there. Let's talk to her.

We ended up in one of the meeting rooms for almost another 40 minutes. The first ten to fifteen minutes the door was open. Dr. Smiles' office was right next door. You could hear everything.

First he walked down the hall to meet some obnoxious woman's twins. I say "obnoxious" because Mr. Hope told me she'd brought the twins into the main waiting room and struck up conversations with other women. Women who were NOT there with twins. There are signs in the office that specifically ask that you not bring children with you out of sensitivity to other patients. On the sign it actually says that if you'd like to bring your kids back for a visit to call the office and they'll arrange for you to do it outside of normal business hours.

So we heard him cooing over the twins. And then we heard him talking to a woman he was releasing to her OB. Clear as day, I heard him telling her how perfect her hormone levels were, how right on target the baby's growth was. Milestones I hadn't hit. Milestones I'm terrified I will never hit. When he said, "I can't wait to meet this baby," I felt like I'd gotten kicked in the gut.

Eventually the UnproRepro came into the room and talked to us about a blast she had. One blast to add to the one we have on ice. We asked if there were any other sets that maybe had more embryos at 2PN. She had a set of 2PNs we could have but there were only two embryos total, which meant having to grow them out. No guarantees of any blasts there.

She handed us the profile of the blast and then said she'd go pull the 2PN one so that we could see it, to, We told her we weren't trying to be difficult but we were hoping there'd be at least the possibility of genetic siblings. "That's unusual for donor embryo," she told us. But it's not, not really. The matches that many of the women in my FB group have made have been with larger sets. One woman was given eight! And she went through a regular clinic like we did, and not through a larger program like the ones at NEDC or FIRM.

We asked about donor egg. Not so that we could mix it with Mr. Hope's sperm but so that we could maybe make our own double donor embryos. Frozen eggs are $2,000 a pop. For $8,000, we might end up with four embryos but more likely we'd end up with two.

I felt frustrated, like the UnproRepro may have actually had better things in her database but was just this super-strict gatekeeper who didn't like me very much. But it's more likely that my clinic just doesn't have a ton of embies. Especially not now that word about donor embryos is growing. I think the wait lists are going to get longer and longer.


Something was wrong with the UnproRepro's computer and she couldn't print the other profile but promised to send it to us later over email. So, we left the office around 12:30 and headed off to lunch with the BFF as a thank you for all of the love and support she'd given us.

Then we drove to Quirky's office for a counseling session. She was very concerned about how matter-of-fact I was about everything. She keeps telling me that it's almost like I disassociate from my body - that I am hovering above the situation, reporting on what's happening down below. This, she thinks, is my defense mechanism. She's probably right.

I did break down at one point - I can't remember why - but honestly? I haven't cried a ton though this. I cried when I realized I would likely lose the baby at home. I've had a few jags here and there. I almost lost it on my trip at an exhibit commemorating 9/11. But for the most part, I still feel kind of numb and flat and blank.

Quirky's concern is that I process my  miscarriage before jumping into another cycle. But I'll be honest: If I could start that next cycle today I would. Yes, I'm grieving the loss of Nugget. I will always grieve that loss. But I am so ready to be on the other side of this. To have a healthy, successful pregnancy. To deliver a healthy, happy baby. To be a mother. Is it any wonder why I want to press the fast forward button to get there?

I'm back to work today and I wish I wasn't. I'm definitely not 100% ("okayish" is the word I've been using). I'm functional but I wish I had the luxury to not be functional, if that makes sense. But life goes on and things at my job are blowing up and I need to be in the office doing my part. It's just the way things are.

Also: I'm sorry that I haven't responded to the sweet comments some of you have left. I'm getting there, I promise.

Monday, January 19, 2015

my cytotec nightmare.

I don't even know where to begin.

Sunday I returned from my trip. I gave Mr. Hope the souvenirs I'd purchased for him. I loved on Precious Pup. And then I took a shower, to make sure I was squeaky clean before I inserted two Cytotec tablets in my vagina per doctor's orders.

A few hours later, I started to feel cramps. The cramps got stronger and stronger, until they started to feel like really bad period cramps. I do my Google thing. Sure enough, I start reading stories about women who were given Cytotec (a.k.a. Misoprostol) to help aid their bodies in miscarriage at home. 

I post the following to my super secret Facebook group:

Was anyone given cytotec to take vaginally before a D&E or D&C? The doctor told me I'd take them to "soften my cervix." I put two in at 4:30 and now I have the worst cramps. I'm supposed to insert four more before bed and two more in the morning. I'm terrified I'm going to start bleeding and passing the gestational sac at home, which I didn't want to do (and why I asked for the D&E in the first place). I Googled and read accounts of women who were given lower doses than I was to miscarry at home with medical assistance and now I don't want to take any more of the pills. Also I was given Vicodin for the pain but I thought I wasn't supposed to take them until tomorrow before the procedure, but I was also reading about women who were told to take them while on the cytotec. I'm kind of freaking out right now, so any insight/advice would be helpful.

Right after I post this, I go to the bathroom. There is a dot of pinkish red blood on the toilet tissue. Within fifteen minutes, the dot has turned into a light flow. Fifteen minutes after that, that flow has gotten heavier.

This is when I start to panic. I don't have pads in the house. I'd forgotten to get them when I filled my Vicodin prescription. My BFF was going to purchase some and bring them in the morning. I text her to let her know what is going on and to ask if she's purchased the pads yet. No response; the message has been delivered but not read (thank you, iPhone, for my favorite feature ever).

I call Posh Clinic to have the on-call doctor paged. Thankfully, Dr. Colleague is the one on duty. I don't think I could've dealt with the coldness of Dr. Eyeore and I would've likely taken Dr. Smiles' head off. How dare he give me this drug and not prepare me for what it would do? Literally, he told us nothing beyond "soften the cervix." He did say the Vicodin was for the cramping but since he told me to take it an hour before the procedure I assumed that the cramping came afterward.

In other words, I knew nothing. 

I start to cry.

I say to Mr. Hope over and over, "I don't want to do this here." This meaning "lose our baby." Here meaning "in our home." 

I know that some women prefer to do it this way, in the comfort and privacy of their homes. But I am the woman who knows which sweater I'm wearing to the procedure so that I can donate it immediately after. I am the woman who planned to wear a blackout sleep mask and blare Bollywood dance remixes through noise-canceling headphones so that I could deprive as many of my senses as possible. If I could somehow NOT be present at my own miscarriage, I would make that happen.

I cry even harder. Mr. Hope cries with me as I sob into his lap and say, "I want my mom. I want my mom. I want my mom." 

How is this even happening? I had a plan. I was prepared. Now, this?

The responses from my FB group started coming almost immediately. Two women share that they were given Cytotec to induce labor. Others confirm what I've already read. All of them are horrified on my behalf.

I use a heating pad to help with the cramps. Forty minutes pass and I haven't received a call back from Dr. Colleague. I dial the emergency line again. This time, the phone rings back three minutes later.

Dr. Colleague sounds mildly horrified that Dr. Smiles hasn't prepared me for what the Cytotec would do. "I'm so sorry, sweetie," she keeps saying. In her experience, about 50% of the women who take the Cytotec end up miscarrying at home before they make it to the procedure. 

But I didn't want this, I tell her. Dr. Smiles knew that. And I wanted testing. I wanted to know why this happened.

She asks me if Dr. Smiles gave me a specimen cup.

"No," I say. "Literally, all he said was 'soften the cervix.' He didn't even tell me there was a possibility I could bleed at home."

Not to worry, Dr. Colleague says. Run a Tupperware container through the dishwasher to sterilize it. That will work. 

She explains to me that I can't have a D&E without the D (dilation) part. And that is what the Cytotec is used for. The fact that I started bleeding so heavily so quickly tells her that my body was ready to expel. It makes sense; Nugget's heart had likely stopped 10 days ago. We were using the hormones to trick my body into holding onto her a little while longer.

I get more apologies from her for having to go through this unprepared. She gives me more information, like how I may get diarrhea from the medicine - nausea too. I could also run a low-grade fever. 

And I do have a little bit of nausea, but it's mixed with hunger because Mr. Hope and I never actually ate dinner. It's about 10:15 when I ask him to make me a grilled cheese sandwich so that I can take half a Vicodin. He does. It's the best grilled cheese sandwich he's ever made. 

The bleeding grows heavier. I send more text messages to the BFF. Now I'm in a double pickle. One, I don't have pads. Well, that's not entirely true. I have panty liners and one thick bad leftover from a retrieval. I don't want to leave the house because I'm afraid of the bleeding. I don't want Mr. Hope to run out and get some because I don't want to be alone. 

I text the BFF's daughter. No response. I text her son: "Is your mom sleeping? If not, can you tell her to check her phone? It's kind of an emergency."

Finally, a response! The BFF runs upstairs to get her phone, where it's been charging. She tells me to call her. I do. I fill her in on what's been happening. I ask her if she can text Mr. Hope a picture of the kind of pads I need. She says, "I'm going to get some and bring them over. I wouldn't even know what to tell him to get."

She arrives a little after 11 with the longest, thickest, wing-iest pads I've ever seen. "I got you what I would've wanted," she says. Then she hands me a small white box. "I was going to give this to you tomorrow, but I figure you could use it tonight." It's an orange calcite - a beautiful crystal purported to have healing powers. She got it while we were on vacation.

I hug her and cry into her shoulder. When I pull away, I see she's been crying too.

I try to find the silver lining. "So far it's just been blood, no clots. So maybe all I'll do is bleed."

The BFF leaves. I go to the bathroom...and pass my first clot.

[WARNING: This is about to get very graphic. Please stop reading if you're at all squeamish.]

Mr. Hope puts an old plastic colander in the toilet to catch any large clumps of tissue. I get a glass dish that's recently been in the dishwasher and store any large chunks there. We can't figure out if we should refrigerate it or not, but we do just to be safe. 

Every time I go to the bathroom, I retrieve the glass bowl. I pull tissue off the TP and deposit it there. I pull tissue out of the colander. My hands get blood on them every. single. time. I turn into Lady Macbeth trying to wash them clean.

I know that I'm looking for whitish-gray clumps. I pass some tissue with a whitish-gray streak in it. I add that to the glass dish.

The cramps get stronger, so I take another half of the Vicodin. This puts me over the edge, and around 1 a.m. I start to pass out on the couch. I make one more trip to the bathroom before putting myself to bed.

I sleep through the night. When I wake up at 6 a.m., I feel very wet. I get up and retrieve my glass dish from the fridge and then head to the bathroom. I pull down my pants and go to sit on the toilet but Mr. Hope has closed the lid, so I end up sitting on that. I hop back up almost immediately, lift the lid, and sit back down.

My undies are covered in blood. The pad has soaked through. There are streaks of blood on my pajama bottoms. When I wipe there is so much blood. I add more clumps to the dish. I wipe some more. I use fragrance-free wet wipes to clean up some.

That's when I see it: the thick blob of bloody tissue on the corner of the bathroom rug. It must have slid out when I first took my pants off. I start picking up the chunks and adding them to the dish. 

It's around this time that I realize I am unnaturally calm. Inside I am horrified by what's happening to my body, not to mention the things I have to do because of it. But I am at the same time weirdly flat. I am examining the chunks to look for the whitish-gray tissue. I wash my hands half a dozen times in between.

I feel like I need to poop but I'm afraid to poop because I know that means I could expel more stuff. But I really, really feel like I need to poop. So I get up, take the colander out of the toilet, and sit back down. I let out a little gas and feel a huge whoosh.

No. No no no no no -

I see it in the bottom of the toilet. A very large lump of something. Without any hesitation I plunge my hand in and pick it up. It takes up most of my palm.There are silvery streaks running through it and on one side is a crescent-shaped clump that's the right size and color to be Nugget. I don't know if it actually is, but I add it to the dish because I know it's significant. I just know this.

I'm pretty sure I just miscarried my child.

I cover the dish and return it to the fridge. I put a stack of paper towels over the spot on the bathroom carpet. No sense in laundering it now, when I don't know what's left to come. 

On the plus side, I am not really cramping and I'm definitely not in pain. Maybe the worst of it is over? 

My appointment isn't for another three and a half hours. I don't know what will happen between now and then but I do know that I'm terrified about the nearly one-hour drive to the clinic. I'm still in a rental from the accident. We'll need to put down towels. What should I wear? What CAN I wear? The only jeans I don't care about are a little snug. Do I maybe have some old workout pants?

I'm flat and numb but deep inside I'm still really, really angry at Dr. Smiles. He should've prepared me. Or warned me. Or something

Losing Nugget has been one of the worst things I've ever had to deal with, and that's saying a lot. (I had a pretty horrific childhood. My late 20s to mid-30s weren't so hot, either.) But I feel like he made it so much worse but not telling me what would or even could happen.

Three and a half more hours. I just have to make it three and a half more hours and then they will remove whatever's left and send me on my way.

I just hope I can make it.

Thursday, January 15, 2015

what to expect when you're expecting a d&e.

Yesterday, I talked to a nurse at my clinic to ask about the D&E procedure. It was Nurse Special, who's like 80,000 years old. I told her that I didn't think it was humane to perform it when a woman was awake and 100% conscious. She seemed to think I was nuts. She said, "We do it all of the time. It only takes about three minutes." Oh, only three? This procedure is getting shorter every day.

I told her I didn't want to be awake. I didn't want to hear anything, I didn't want to feel anything. She confirmed that I would feel pain. I said, "There's PAIN?" And she said, "Well, I've never had one, but yes, you're going to feel a lot of cramping. You should call the doctor. He's at the other office today."

So I call the other office. The message I give the front desk woman is this: "Please tell him there's NO WAY IN HELL that I am going to be awake for this thing." She takes my number and tells me he'll call me back.

I get the call while I'm at work. In a meeting with one of my staff. I tell her I have to take it and send her off, closing the door behind her. My doctor is not amused by my message. He tells me that when he does the procedure in the office, there's no sedation. If I'm not comfortable with that, I'll have to call my OB. I tell him I don't have one. He says, "I can refer you to someone else."

This I don't understand. I get Versed for my egg retrievals. Why can't I get it for this?

Because, he explains, that part of the clinic is for the IVF side. Not the physician side.

The clinic is attached to a hospital. When I had my hysteroscopy, it was done there. Can he do the procedure at the hospital?

No, he says. I do it in the office or I don't do it at all.

Now I'm in a pickle. The last time I let someone do surgery on my lady business, I came back with one ovary. This after everyone told me that there was no way I'd lose my ovary. That doctor was a complete son of a bitch and the reason I don't have an OB anymore (and why my primary has done my paps/breast exams two years in a row). 

I trust Dr. Smiles. Not because he's a famous doctor who's been on TV several times, but because I know his top priority is preserving my fertility. He's not going to cut anything or scar anything or do anything to compromise my ability to make or carry a baby.

Look, he says, it's really a quick procedure. It only takes a few seconds.

Two things:
  1. Oh, so now we're down to SECONDS? Is this meant to comfort me? I'm stuck on the math: Four years. Nine weeks of pregnancy. Undone in mere seconds. Yeah, that doesn't make me feel better.
  2. I can't help but think of Hemingway's "Hills Like White Elephants": "'It’s really an awfully simple operation, Jig... It’s really not anything. It’s just to let the air in.'"
Fine, I tell Dr. Smiles. Let's keep it on the books and I'll call you if I change my mind.

I email Mr. Hope. I email the BFF. I talk about this with two of my closest coworkers. Everyone is horrified that I will be awake for this procedure. 

Dr. Smiles had said I could take two Vicodin an hour before. This, he feels, will make me really loopy. 

That's great and all, but here's MY plan: 

I'm going to wear a sleep mask. I do this whenever I have to get an MRI and it helps. If I can't see it, it doesn't exist!

I'm going to load some speed metal on my iPhone and listen to it through noise-canceling headphones. I don't want to hear anything but obnoxiously bad music. I know if I hear the suction as I feel it, it will give me nightmares for the rest of my life.

I might bring a stuffie. Something to squeeze. That something will not be my husband's hand. This is how he lost a close relative, remember? He will be in the waiting room with the BFF, who's coming with us. Yep, I'm bringing her for him, not for me. Me, I'll have a stuffie. Preferably one I don't care about donating to Goodwill immediately after.

So this is my plan. I'm still terrified. I'm not good with pain, physical or emotional. I have such a freakishly good sensory memory that unless the Vicodin really wipes me out, I will remember every single second. I will relive every single second over and over and over again.

But the fear of having someone botch the job is way worse than the fear of pain. I need my ladyparts to work. I need there to be no scarring. I need to know that when we cycle again, there will be nothing standing between us and our rainbow baby.

So, awake it is. 

Let's hope I don't regret it.

Wednesday, January 14, 2015

miscarriage to-do list, day 2.

Log into BabyCenter and "delete" your family. This will stop all emails related to your pregnancy, including any pesky advertiser emails for things like breast pumps, diaper services, or winning free cord blood storage. Also, when you delete your family, they automatically take you to a list of miscarriage resources. That's convenient.

Log into BabyCenter under the name and password you set up for your husband, because he was totally into the weekly emails you were getting about your pregnancy and the state of your uterus. Delete his family, too. Then log into his email, search "BabyCenter," and delete every email he's received from them, eliminating all painful reminders that for a brief five-and-a-half-week period, you were expecting a baby to arrive this August.

Run through the list of people you updated yesterday to see if you missed anyone. Realize that there are still three women from your old, in-person Resolve support group you haven't told about the loss. Also a family friend who may or may not be reading your blog. Four more people to tell, and that should be everyone, right? No, there are two others from that support group you told, too. Or is it three? Do a quick count. Realize that a whopping 24 people knew about your all-too-brief pregnancy. More, actually, because you're just counting the people YOU told, not the ones your husband told, or the ones that were told by the people you told. Even so, 24 personal contacts seems excessive. You thought you wouldn't care about having to tell these people about a miscarriage. (You were wrong.)

Overanalyze every little twinge and cramp. Why do you feel like you're about to get your period? Are those miscarriage cramps? Oh, no, you just need to go poop. Visit the bathroom to confirm. Yep, those were poop cramps. Later, after you've scrubbed your hands in hot, soapy water, explore your cervix to check for bleeding. None of that happening (yet). Breathe out a sigh of relief.

Consider having sex with your husband. There's nothing sexy about  miscarriage, but you've been craving physical closeness with your husband since you first knew the pregnancy was in trouble. It's been months since you've been intimate (that's IVF for you!). Worry not about the sex itself but what happens if you happen to orgasm. You've been told not to because it could cause uterine contractions. Will those uterine contractions be strong enough to expel a fetus that you're trying to hold in for five more days? Decide to remain celibate.

Get morbid. It's weird to you that you're carrying a deceased, grape-sized fetus in your uterus, isn't it? Weirder still that you're taking her on vacation. But that vacation was already planned. You look forward to this vacation every year. The hotel is nonrefundable! You have to go. Have to. But what will happen to her over the next five days? Even though your doctor told you to drink your face off, you can't help but feel doing so would be toxic to the baby who no longer is. I mean, you get that she's gone - that her little heart is no longer beating - but still. She is in your womb. What effect does alcohol have on a fetus that is no longer growing? Is this something you need to be concerned about?

Call your clinic to see what options you have for the D&E. You can't fathom having to be conscious for the evacuation of your first and only pregnancy. It seems cruel. Inhumane. Get a message that reminds you the office doesn't open for another hour. Fuck. You'll have to call back later.

Move forward. This is happening. It's really happening. On some level, you know this. On another, it hasn't fully sunk in. But it will. If not now, then soon.

Tuesday, January 13, 2015

and the newest member of the miscarriage club

The first thing I noticed at this morning's ultrasound was that the sac looked much, much bigger. For a second, I thought, "Oh, look! It grew!" But then the ultrasound tech started measuring Nugget, instead of pointing out where her heartbeat was, and I knew.

Nugget was gone.

I said, "There's no heartbeat, is there?"

"No," she said. "How did you know? Had you stopped having symptoms?"

"Actually, those have been worse," I told her. "But my hCG levels have been off from the start."

"I'm so sorry," she said. "Truly."

"It's okay. We've been expecting this."

And we have. I wasn't shocked. I didn't cry (not then, anyway). If anything, I was more worried about Mr. Hope, who'd been dreading this appointment all week. 

We went to the smaller waiting room, where we'd sit until we could talk to Dr. Smiles. I texted the BFF. "No heartbeat," I wrote. "Waiting to see the doctor."

Not too long later, a nurse led us back to his office. She told us how sorry she was and gave us the Sad Face. I told Mr. Hope, "This is almost worse - how everybody reacts." Then Dr. Smiles walked in with his version of Sad Face and it was like a little knife in my heart. We'd been in this together, after all.

We talked next steps. I was clear that I wanted the D&E. (Quick side note: the more standard procedure is a D&C, which includes scraping the uterus. My clinic doesn't do this. They use suction to clear out what people in the biz call "products of conception.") Then I said, "There's a complication. I'm heading out of town on Thursday and I can't cancel my trip."

"We can get you scheduled for tomorrow," he said. "And then you can leave for your trip on Thursday."

But all I could think was what if? What if there were complications? What if there was a lot of bleeding? Or cramping? Or worse?

I said, "Can we do this after I get back?"

Mr. Hope says the doctor gave me a look here, but if he did, I didn't register it. At any rate, he said I could. I asked him if I should stay on the hormones until the procedure. "You'll want to," he said, "if you want to make sure you won't bleed."

So now I'm off PIO and the Lovenox but will stay on the estradiol and progesterone suppositories until Sunday afternoon. At that point, I'll start inserting tablets into my vagina that will soften my cervix and open it up. Two at first, then four that night, then two again the next morning. An hour before the procedure, which is scheduled for Monday, I'm to take Vicodin.

I ask about the donor embryo program. We only have one left on ice. Can I get matched with another set so that I will have more to transfer?

Absolutely, he tells me. I just need to email the UnproRepro to set it up. 

(Fabulous. I thought I was done with that one.) 

We're looking at March, he says, for our next transfer. Of course it will be March. My anniversary month. The month I have a two-day work trip three states away. A speaking engagement, no less.

But okay. March isn't that far off. I can hold onto March.

Dr. Smiles tells me to drink my face off on the trip. "That's already on the menu," I assure him.

Then he tells us how sorry he is one last time, and sends off to check out. I tell the front desk woman that I need to schedule "a procedure." She looks at my file and gets it. She's sorry and Sad Faced, too.

But here's where things get weird: I ask if I should stop eating and drinking at midnight, and they tell me no. The nice nurse from earlier walks by and says, "Oh, no, we prefer you to eat a light meal." 

"No twilight sedation?" I ask.

"No," they tell me. "Not for an office procedure."

Huh. I really thought I was going to be out for this one.

I ask how long I should to expect to be there. 

The nurse says, "We always say an hour, but really, it takes no time at all. More like 15 minutes."

Four years, we've been trying. Four years and a nine-week pregnancy, and they can undo it all in a quarter of an hour? 

And this is when I start to lose it. 

Mr. Hope and I say our goodbyes and walk out the door. We pass a bathroom in the hallway and I duck in. "You're going to start crying," he says.

"No, I'm not," I say, but I totally do.

All of my hopes. All of my dreams. All of it, gone. Fifteen minutes of vacuuming out my uterus and I will be returned to my pre-pregnancy state, almost as if it had never happened.

Except it did happen. For five and a half weeks, I was a pregnant woman. I was a mother. There was a tiny human growing inside of me. I still carry that grape-sized, stalled-out baby seed in my body. 

We walk back to the car. And, because we are two fat people who have a tendency to feed our feelings, we swing by the little bagel shop near the clinic to load up on carbs. On the way home, we stop at my favorite pizza shop. The universe defaulted on my no-pizza-until-13-weeks pact, so fuck it. I'm eating the pizza. 

At home, I clear out some work emails and make my to-do list. There is so much that needs to be done, but I can't focus. I don't want to work. I want to shut down.

An hour later, I climb onto the couch next to Mr. Hope, and we start binge-watching a sci-fi show we like. I check work emails to make sure I'm not missing anything crucial. 

At some point, the vet calls to tell me that Precious Pup may still need the surgery that we thought he needed Friday but then was told he didn't. The story is always changing. We were told one thing and then another and then a third thing today. I ask a lot of questions. My voice is sharp and I can hear the panic in it. I tell the vet that I don't understand why they keep changing the story and I'm going through a miscarriage to top it all off and I can't even right now -

I toss the phone to Mr. Hope, lock myself in the bathroom, slide down to the floor, and cry my eyes out.

There is so much going on in my brain, I can't even begin to process it all. I was a mother, and now I am not. (For now. Hopefully.) I'm going to have to go through all of it again. The preparation. The transfer. The five days of waiting, waiting, waiting until I can test. Getting positives. Hoping they turn darker. The nervousness of the beta tests. Hoping (praying?) the numbers rise appropriately. Knowing I will be gutted if they don't. Or, worse, what if I don't get a positive test? What if I transfer two more and neither of them take? 

I was emailing a friend earlier who had a negative cycle after a miscarriage and I said, "I can't even imagine how hard that is." And I can't. I can't imagine going through a loss like this, waiting for a second chance, and not even making it to first base. 

And then there's this:

Unless there is some major miracle brewing in my future, I will most likely never have a biological child. And yes, I knew that was my fate. And I'm okay(ish) with it. 

But being okay(ish) with it and then having to accept that your very last shot - that beautiful, unexpected blastocyst created from your egg and your husband's sperm - having to accept that it's gone, gone, gone -

It hurts. It hurts more than I thought it would.

As I type this, I hear Mr. Hope crying in the other room. I should go to him right this second. 

I'm afraid that it might break me.

We've been through so much together, Mr. Hope and I. But this? This is one of the worst things. One of the hardest. I don't even think I've begun to fully hurt yet. And I can't imagine the pain of Monday if I need to be conscious during the procedure. I need to call the clinic about that tomorrow and see what can be done.

For now, I need to go to my husband. I need to hold him. I need to let him know that he isn't going through this alone.

That we will get through this together.

We always do.

dreams of my mother (and other charming nighttime tales).

Sixth ultrasound today at 9:30. Per usual, I have no idea what we'll see. I know this weekend I only had a couple of weak uterine twinges where Nugget implanted, which made me nervous. The daily knock-knock from the baby has been comforting to me during this limbo. Then, yesterday, I had a series of strong knock-knocks. Three sharper twinges in a row each time. They felt a little like the implantation cramps, actually. I hope that means Nugget was snuggling in for the long haul.

The past three nights I've had the most vivid dreams/nightmares. Saturday night, I had this horrific one in which a doctor whose name I couldn't pronounce (in the dream I actually took a picture of his door with my phone because I couldn't remember OR say his name) told me that most doctors wait their whole life for a patient as "special" as me. "You will never carry a baby to term," he told me. "There is something in your body that attacks the fetus. This baby inside of you, it will never make it. You will never be a mother."

You don't need a PhD in psychology to decipher that one. But later, in the same dream, I am wandering the streets of this lakeside town looking for my dead mother. I eventually find her. She doesn't look dead - she looks like a normal person - but in the dream I knew she was dead. I tell her about what the doctor said and how I think that it's because her genes were broken and that's what I inherited. She was eating popcorn or some other snack and was all, "Whoa, that's intense." Because yes, when I encounter my dead mother in a dream, she acts like a college-aged stoner.

Sunday night saw me locking Mini-Hope in the trunk of a car - to be fair, she voluntarily got in, but then we forgot about her - and Mr. Hope trying to rescue a stray tabby that was covered in fleas. Literally, I looked down and saw the cat's fur and it looked like it was moving, there were so many fleas. Mr. Hope was wearing a sweater and the fleas started nestling in that as well. I was panicking and kept saying we'd need to walk around until we found a shop where we could get them both dipped (the cat AND Mr. Hope).

And last night? There was another crazy vivid dream, though less nightmarish. It had a plot, as most of my dreams do, and when I woke up and was like, "Okay, three in a row," I knew I'd write about them. Only now, sitting at my laptop, I can't remember last night's to save my life.

I know that vivid dreams are a common pregnancy symptom, but from what I've read they're the result of hormonal changes. I'm on a shit ton of hormones (2 mg estradiol 2/day, prometrium suppositories, PIO) so that doesn't necessarily reflect Nugget's current state of being.

Other "symptoms": The soreness of my boobs waxes and wanes (this morning they're super tender, but at times I feel nothing - I walk around the house mushing them in my hands and just hoping they'll start to hurt). Sometimes I get heartburn, but not often. Harold has been behaving himself lately, so that's been nice, but at the same time, I'm like, "Well, what does this MEAN?" Oh, and I'm thirsty a lot. I've been drinking a ton of fluid and yet I still wake up dehydrated almost every morning, but it's been really cold and the heat runs all night (even though I have it set at 65) so maybe that's why?

The biggest thing is that I'm tired all of the time. Over the weekend I thought I was coming down with something because I'd just get dog tired in the middle of the day. Granted, I had a Friday like you wouldn't believe - I won't go into details, but I will say there was extended drama over Precious Pup's vet visit and about four hours where we thought he needed emergency surgery but then didn't in the end - so maybe the exhaustion is from life itself. I wouldn't be surprised.

I'm hoping that Nugget has lived to see another week. If she can just hang on until next Monday, I can get the MaterniT21 (non-invasive) blood test and see what's the what with her chromosomes. (Or his. Nugget could be a him. The baby implanted more on the right but the yolk sac implanted to the left of the baby, so this is why I think Nugget is a girl. Either that or it's wishful thinking.)

In my fantasies, we get that test and it comes back clean, and I'm just this weird medical mystery where everything looked bad but we still end up with a healthy, happy little baby. I know this isn't the likely ending (I said "in my fantasies," remember?) but I want so desperately for this happen. I've been in pregnancy limbo for a full month now, which doesn't sound like that long but feels like an eternity. And even though the sac looked small too weeks in a row, the baby's heart beat strong both times. I hang on to that heartbeat. I have to.

Right now, it's pretty much all I have.

Wednesday, January 7, 2015

losing my marble.

Y'all know by now that I love a good story, right? Well, have I got a story for you!

Our fifth ultrasound was scheduled for 9:30 a.m. yesterday. Of course, this was the morning that we had our first real snow of the season. We live in an area that doesn't see a lot of the white stuff, and drivers start freaking out at even a sugar dusting. So, we planned on leaving about 20 minutes early to accommodate.

An hour later, we'd barely made it from the first Interstate to the second. (It usually takes us 20 minutes to reach the second one.) I try to call the clinic to let them know we're going to be late. Their phones are down. It takes us about six tries to realize it's not OUR phones that aren't working.

Of course, after an hour on the road I had to pee. Badly. Remember how I said this pregnancy peeing is no joke? So I asked my husband to pull off at the first exit. He obliged. The exit ramp is covered in slippery snow. The car's brakes lock up. We're going slowly but it's clear that we're about to hit the big orange HVAC truck in front of us. Mr. Hope tries to go around it. No such luck. We sideswipe the truck in extreme slow mo.

The truck moves off the exit ramp and into a lane. We follow suit. There are horrible scraping noises and I realize that the accident has completely destroyed our front right tire. I tell Mr. Hope to stop driving. He keeps moving anyway. Finally, he reaches a place where he won't cause more traffic issues. We sit there, stunned.

I still have to pee.

I tell my husband I'm going to walk to find a bathroom. And then trudge maybe 1/3 of a mile in the snow until I find a little salon. It's closed, but as luck would have it, the woman who's there to open it has just pulled in as I am knocking on the door. I tell her what happened and she lets me use the bathroom. Then she says I can wait there until help comes. I thank her and say I need to get back to my husband.

I trudge back. By this time, my feet are freezing and slightly wet.

The police have been called. Mr. Hope has called the insurance company. When I get back, I dial AAA. They inform me that I have only purchased a Basic membership, so it will only cover the first three miles of towing. Each additional mile will be $4. I could've sworn I purchased the Plus membership. They tell me I did not.

I cancel the tow.

The cop arrives while I'm on the phone with AAA. He tells me he's calling a tow because we have to move our car. I'm all fine, whatever. I'm still trying to figure out how we're getting home and if we're going to be able to get our ultrasound.

Mr. Hope decides he's going to call AAA and play dumb and see if he can upgrade our membership. He wastes like 20 minutes on this endeavor. No go. Meanwhile, I'm grabbing a reusable grocery bag from the trunk and loading up all of our stuff - the GPS, the EZ Pass, car chargers, etc.

The tow guy that the cop called shows up and tells us he's taking the car to his collision center. But I don't want the car to go there. I want it to go to the awesome body shop that's less than a mile from our house. Tow guy says, "I'm not AAA."

The tow guy starts hooking up our car. I tell him that I don't authorize him to take it anywhere. He says, "I don't need you to. He did." Pointing to the cop.

This is when I kind of lose my shit.

I start screaming at the tow guy that he can't take my car, that my car needs to go to MY body shop, not his, and that I'm not getting into a truck with him.

The cop is talking to the guys we hit. I stomp through the snow over to him and ask him what's happening. I say, "You told me you were calling a tow truck. You didn't say I couldn't pick where the car was taken." He says, "I told you that you have to move your car." I say, "But I don't want my car taken there. I want to get home." He says that's not how this works. We're blocking a travel route, see. It's dangerous. I say, "Can't he just tow the car to that lot right there? So it's out of traffic?" Cop says, "He's not AAA."

I walk back to Mr. Hope and start crying. Like, wailing. Hysterical crying. I start talking about how I'm eight weeks pregnant and I need to get my ultrasound and I have to get home so I can get my ultrasound and why can't they help me?

Tow guy takes off with our car. Cop asks us if he can give us a ride to someplace warm. I tell him no. I walked somewhere once, I'll walk there again.

I head back to the salon. On the way I call my mom's best friend, who's been like a second mom to me for years. We're going to call her Bossy, but in the best possible way; she's a woman who gets shit done. I say, "There's been an accident. We're fine but stranded about 20 miles from home."

She says, "I'm in the shower. Give me ten minutes and I'll call you back."

So we wait in the salon. Mr. Hope calls the body shop and fills them in on what happened. They get the other collision center's number from him and tell us they'll take care of everything, including getting our car towed to their place AND rolling the cost of it into our insurance claim. (WE LOVE THIS BODY SHOP!)

Somewhere in all of this, I have called my clinic's sister location. Their phones ARE working. I tell them what's happened and they tell me they'll let my clinic know.

Eventually Bossy calls and gets some information from us as to where we are. I tell her about the missed ultrasound. She tells me to call my clinic and ask how late I can come. "If they'll take you, I'll drive you there."

So I call the clinic and miraculously get through on their previously broken phones. It's about 11:15 at this point. The ultrasound tech leaves at 12. We're only 12 miles from the clinic. They ask the ultrasound tech if she'll stay a little late to accommodate me. She says yes. Score!

Around 12, there's still no sign of Bossy. I call to see where she is. She's just gotten onto the first Interstate. She had a work emergency she had to take care of.

I call the clinic back but their phones are broken again. So I call the sister location. Turns out their ultrasound tech is there until 2:30. If we want to try to make it, they'll see me.

Bossy arrives at 12:30 and I let her know about the sister location. It's a half-hour drive from where we are. "Let's go," she says.

We get there and wait for about 20 minutes before being taken back for blood work. This is around 1:20; we haven't eaten since 8 a.m. I didn't pack snacks because hey, I didn't think we'd be stranded on the side of the road. I am starving. And nervous.

Finally, around 1:30, we have the ultrasound. There's Nugget, her little heart still beating. But I can tell the ultrasound tech is concerned. She takes more pictures than normal. More measurements. She measures the heartbeat. It's 130. Lower than the 144 it was last time. (Later, after I get home, I do some research that reveals low blood sugar can affect the heart rate. Even so, 130 is still in the normal range.)

There has been growth. Nugget measures 12.3. She was 7.3 at the last scan, so they would've liked to have seen her measure 13 or 14. But she's still in the acceptable range.

It's the sac that is not doing so great. No one ever tells us that the baby is measuring this week and that day, they just give us numbers. But you can see what things are measuring at on the screen. By the screen, Nugget is measuring at 7w4d - so, about five days behind. Not catastrophic. But the gestational sac is measuring at 6w4d - almost two full weeks behind. It's small, that's for sure. Nugget is kind of crammed in there. Here, see for yourself:

So I guess all of the water I've been pounding didn't help.

The ultrasound tech says, "Do you want a picture?"

Right there, my heart sinks to my feet. She wouldn't ask us that if she didn't think this was going to end badly.

Yes, we say. We want the picture.

It is still our baby, for now.

We are somber as I get dressed. We still need to talk to the doctor but we both know it isn't good.

It's another 10 minutes before a male voice calls us back. Oh, crap. I'd assumed we'd get to see sunny Dr. Colleague. Instead, we got saddled with Dr. Eyeore.

He is his usually gloomy self. He starts talking to us about how a small gestational sac and enlarged yolk sac typically indicate chromosomal abnormalities. He and his wife went through it. Twice. This, we suppose, is his attempt at bedside manner.

Sometimes a too-small gestational sac can catch up, he says. He's seen it happen. But, this isn't likely. At least not for us. I'm guessing he makes this characterization based on my poor hCG levels in conjunction with the too-small sac.

This pregnancy, he tells us, will declare itself in the next seven to ten days. He says this a few times, actually. I imagine Nugget becoming Foghorn Leghorn and saying, "Well, I do declare, I don't think I'll be sticking around heeyah."

There's nothing we can do, he assures us, just as every doctor has done every step of the way. "Whatever's happening is happening from the inside out," he says, "not outside in."

I ask about MaterniT21 Plus, a noninvasive blood test that identifies a wide range of chromosomal abnormalities. He's familiar with the test. If we make it to Week 10, he says, we can do the test then.

But clearly he doesn't think we're going to make it to Week 10. He doesn't say this outright, but he does say that he's going to send me home with a cup and that once I start spotting he thinks I should start peeing over an old colander so that I can catch whatever comes out. He says, "A baby this size is about the size of a marble, so you should be able to get that and bring it in for testing."

I say, "But Dr. Colleague said my progesterone is too high for that. She said if I miscarry, we'll find out at an ultrasound that the heart is stopped."

He switches gears. Now he's talking to us about giving me four pills to take that will soften the cervix and allow me to lose my marble in the colander.

I say, "But Dr. Smiles said that if I miscarried, I can do a D&C."

He says, "Oh, yeah, we can do that. We're good at that."   <-- not a direct quote but pretty damn close.

I ask him to reassure Mr. Hope that it's a safe procedure. See, Mr. Hope lost a close relative after a botched D&C post-miscarriage. You can imagine how awesome that's made everything that's going on with me right now. Mr. Hope's #1 fear in life: losing me. This is not an exaggeration. He tells me this regularly.

Dr. Eyeore tells him that they're really good at the procedure. That they use plastic instruments so that there isn't any scarring. That other women come to them to have their botched D&Cs fixed all of the time.

Recovery time is minimal, he says. "Nothing in the vagina for a week."

He wants us to come back in a week and a half. Small problem; that's when the BFF and I will be on our birthday vacation. Can we come back in a week?

"Sure," he says. "Even better. If you come in that morning, we might be able to schedule you for the D&C that afternoon."

Since this now sounds like a 100% done deal, I say, "What are the odds that the pregnancy will pull through?"

He says, "I give you five to ten percent."

Alrighty then.

As I'm checking out, I happen to look down and see my hCG level from last Tuesday. It was 2,281, up from 1,591 four days prior. That's the biggest increase we've seen since the second beta. I have no idea why it picked up like that in Week 7. What does it mean? Is it a good thing?

Later, after I put the numbers into a doubling calculator, it shows a 40-something percent increase in four days - well under the 60% doctors like to see. The doubling time is a week. Much better than the 110 days I saw at one point, but still not enough.

I make the appointment for next Tuesday with Dr. Smiles. If Nugget is gone, I do not want to have the follow-up convo with Dr. Eyeore. I want MY doctor.

We get back into the car and head for home, stopping for food along the way. Mr. Hope and I have had no time to process. We've been with Bossy the entire time. Just before we leave the restaurant, she goes to use the bathroom. It's the first time we've had two minutes alone.

"What are you thinking?" I ask.

"That this sucks," he says.

Yep. That about sums it up.

Bossy takes us to the rental car place. We pick up my new car for the next two to three weeks. There's a warning light on. Low tire pressure. They can't fix it, they tell us. But if there's a guy on the lot he might be able to.

So Bossy tells me to follow her. The maintenance guys on a rival rental company's lot are out. She tells them some sob story and they agree to fill my tires for me. I told you, Bossy gets shit done!

There is more drama when I am trying to back out of the lot - it's very tight, I'm great at parallel parking but horrible at backing out of spaces - and then we head home. Only, we have to stop at the body shop first, because the collision center won't release my car without proof of registration.

I don't walk through the front door of my house until almost 5 p.m. Which is about the same time I'd be getting home if I'd worked a full day.

Mr. Hope and I are thoroughly drained. There are people who've been texting and emailing all day asking for updates. I can't tell the story a million times, so I write one email that goes out to a bunch of people. Then I curl up on the couch with Mr. Hope to drink hot tea and watch Netflix.

Later I did my normal Googling thing. I found a picture of a Week 9 ultrasound where the baby was way more crammed into the sac than Nugget is. I mean, you can still see some fluid around Nugget (for now). This baby was being squeezed tight by its sac. The doctor had prepared the woman for miscarriage and sent her off. Three weeks later, she hadn't miscarried and got another ultrasound. The sac had caught up, the baby was a little small but growing on target, and the doctor gave her the go-ahead to start telling people they were expecting. She went on to deliver a healthy son.

Now, I don't know about that woman's hCG levels. I'm guessing they weren't dismal like mine. But you know, it's something. And even Dr. Eyeore gave us a five to ten percent chance of making it. Nugget has pulled off so many miracles so far. I mean, the hCG had plateaued. Then it shot up almost 700 points in four days. That's something, right?

The thing is, I don't even know how I'm feeling. Like, I'm definitely not okay. But I'm not devastated either. Am I still in shock? In denial? It still doesn't feel real. I don't FEEL like I'm going to lose this baby. But I also don't feel like I'm going to have this baby either.

Another week of wait-and-see. Another week of hormone shots and suppositories and pills. Another week of wondering and Googling and performing my version of prayer, which is really a lot of me thinking, "Please, please, please let this baby make it. Please."

Still pregnant, though. At least for now.

Monday, January 5, 2015

what will tomorrow bring?

I've been relatively relaxed all week. Seven days without another blood draw and ultrasound meant seven days I was still pregnant.

Earlier today I got a little worried. I hadn't had a single uterine twinge. Not long after I emailed this to my husband, there were a series of uterine twinges where Nugget implanted. I felt like she was saying, "Hellooo? I'm still in here, you freak!"

Then, all afternoon, I had pressure above my groin area. I Google this, worried it has to do with miscarriage. Nope, just my uterus stretching. Perfectly normal for someone who is eight weeks pregnant.

I get to a place where I think that Nugget is going to make it. She has to, right? But then I end up Googling and reading scary things, like the miscarriage story from a woman who said her hCG levels were wonky her entire pregnancy, and how at nine weeks the baby was crammed into a sac that had stopped growing. If you remember, at my last ultrasound my sac was a little small. WILL NUGGET OUTGROW THE SAC? Is this what happens when you have dismal hCG levels?

I don't know what we'll see tomorrow. I'm hoping for appropriate growth and a super-strong heartbeat. I'm hoping that the hCG levels don't mean squat. I'm hoping that Nugget is strong and healthy and turns out to be our rainbow baby, the one we've wanted and waited for so so long.

There is so much love waiting for you, Nugget. Stick it out and see for yourself.