The Hardest Thing

Thursday, January 22, 2015

This is not a post I should be writing. The post I should be writing would have happened in about 6 weeks. It would have been filled with joy and hope. Instead, I am writing this post because I feel like grief is seeping out of every one of my pores. From the minute I wake up and until the minute I fitfully fall asleep, I am consumed by it. It feels never-ending.

(Warning: Medical things ahead.)


Awhile back, I mentioned that Ken and I were trying to start a family. It felt a little insane, to try and do that while simultaneously in medical school, but it was what we were doing. The week before Christmas, we had our own little Christmas miracle: I was pregnant! We were over the moon. It was like we were walking on air. We talked about it every day, excited about what our new life was going to be like at the end of August. I worried about being pregnant through the entire summer, and we talked about how we'd manage med school, work, and a baby once he or she was here. We were convinced she was a girl. It was early, but we decided to tell our closest friends and family. Everyone was overjoyed for us; the happiness was palpable. Things were good.

Then, right after Christmas, a tiny bit of spotting. Light brown. Barely noticeable. My anxiety wouldn't let it go through, and I freaked out. The nurse at my OB's office sent me for bloodwork to check my hCG levels. My hCG was high enough for something to be seen in the utereus, so off we went to the hospital for an ultrasound to make sure the pregnancy was in the uterus and progressing. Ken went with me, and we were absolutely thrilled to see our tiny embryo next to a healthy-looking yolk sac. It was in the uterus, it was growing. It was still too early to detect a heartbeat, but that wasn't worrisome. 

On January 6th, we went to my first prenatal appointment with Dr. T. She was wonderful, and after a thorough history and exam, she did an ultrasound to check on the babe. There had been growth, but it was still too small to see a heartbeat. She scheduled me to come back the following week, because by then we would definitely be able to see something. Anxiously, I waited. I went to class. We stared at our ultrasound photo. Our embryo was the size of a blueberry and we were in love.

The following week, I went to my ultrasound by myself in the Maternal-Fetal Medicine department. The ultrasound tech put my images up on the screen, and right in the center, the tiniest of flickers. A heartbeat! I nearly cried with joy. And then my heart fell into my stomach because the tech said, "The baby's heartrate is a little slow, and it's measuring a little small for how far along you are." She took some more pictures and told me to get dressed; the doctor would be in to see me in a few minutes. The doctor who came in, Dr. P, was someone I had never seen before. He introduced himself and then frankly told me what was going on.The good news? There was cardiac activity. The not so great news? The rate was slow and the size was measuring about 2 weeks behind where it should have been. He was cold and unfeeling, and when I asked how concerned we were, he said, "It's basically a coin-toss as to whether you'll be okay or have a miscarriage. Would this be your first miscarriage?" I held it together as he man-splained to me how there was nothing he could do to prevent a miscarriage from happening, and how this was very common. He scheduled me to come back in two weeks for a growth scan. His final words to me? "There's cardiac activity now. There might not be in two weeks. We'll just have to see. Try not to think about it." I sobbed the entire time that I drove home.

Later that day, Dr. T called me and we talked some more. She confirmed Dr. P's concerns; the baby was small, the heartrate was low, and no, we didn't know which way this would go She squeezed me into her schedule the following week so she could do a quick scan. The next week was hell. I read too many academic journal articles, tried to avoid the message boards, tried to keep myself from Googling things like, "Average embryo size at 7 weeks" or "Low heart rate in the first trimester". Every time I found something that was reassuring, three more things were not. I finally made myself stop. I focused on the positive. Our baby had a heartbeat. I am a small person, maybe I just grow small babies. It's so early, it's hard to see things with ultrasound sometimes. I felt pregnant; my boobs hurt all the time, I was nauseated, I was exhausted. I felt like nothing was wrong, and I was sure that if something was wrong, my body would tell me.

On Tuesday, Ken left school early to go with me to my appointment. Dr. T came in and we got down to business. I was filled with hope. Our baby would have a strong heartbeat, as fast as it should have been. It would have grown. We would be talking about due dates and next steps. Instead, Dr. T grabbed my wrist to feel my pulse. Then she said the words I had been hoping and praying not to hear. "I think what I'm seeing is not a normal pregnancy. I could be wrong, I have to have another doctor come in to check. I want to tell you that it does not look good. I'm sorry." She left. I laid on the table and sobbed. Ken held my hand and bent over me to hold me. I felt like I couldn't breathe. I wanted to wake up and have it be a terrible nightmare. Instead, Dr. D came in with Dr. T and looked again. He looked for a few minutes. He conferred with Dr. T. I tried to hold it together, so slow my breathing and to stop from screaming. He confirmed what Dr. T had seen. There was no heartbeat. The embryo had not grown; in fact, it was smaller than the previous week. He apologized. She apologized. They left so I could get dressed. I felt like I was underwater. I wanted to sink into the floor and die. Instead, I put on my pants and we went across the hall.

Dr. T handed me a box of tissues and apologized again for the horrible news. She explained that 25-40% of pregnancies end in miscarriage, and that 80% of those occur within the first trimester. She said that this early, there was almost undoubtedly a major chromosomal abnormality that had caused the pregnancy to end. She reiterated that it was not my fault, that there was nothing that I did or didn't do. That sometimes, this is just a normal and horrible thing that happens. I asked if I had an increased risk of miscarrying again (no). I asked if there was an increased risk of not being able to get pregnant now (no). I asked if my PCOS or endometriosis or autoimmune disease had caused this (probably not). I asked what felt like the insane question of when we could try again (after my next cycle). And then I asked what we had to do next. 

She gave my three options. I could wait until my body miscarried naturally. I immediately rejected this because I could not imagine just waiting for that to happen, Clearly, the pregnancy had ended well over a week ago and my body hadn't gotten the memo. I wasn't about to let it decide when to ruin my life. I could take drugs to induce a miscarriage at home. I also rejected this because I don't think I would have had the strength to swallow the pills, and then to wait for everything to fall out of my body. I needed it to be over and I needed it to be as passive as possible. That left option three... having a D&C, or a dilation and curretage. Yes, that's the procedure they do when an abortion is performed. This was not lost on me. I tried not to think about that part. Instead, we scheduled the procedure for the next day. I needed this to be over as soon as possible. Ken and I went to the car and cried until we were ready to drive. Ken drove because I could barely see straight.

I told everyone in the most impersonal way possible... via text message. I just couldn't pick up the phone to tell anyone because all I could manage at that point was incoherent sobbing. The only person for whom I answered the phone was Sarah. When I picked up and said hello, I immediately started crying and she cried with me on the phone. After a few minutes, there was nothing more to say, so we hung up. I cried the entire way home. We dropped Ken off at his car and drove home separately. I got home first and immediately threw out the folder from Penn, congratulating me on my pregnancy. I took the "100,000+ Baby Names!" book, my copy of Expecting Better, my copy of Love Works Like This, and The Belly Book that I had started filling out, and put them all into a bottom drawer. I threw out the positive pregnancy tests. We laid in bed and held each other and cried. We raged against the unfairness. We grappled with how to hold this much grief at one time. 

Eventually, I showered and washed my hair. He showered. We ordered a pizza. Ken called out of work for the next day and spent the next hour writing up answer keys for his students. I wrote in my journal. I got the Xanax and the Ambien out of the medicine chest. I resisted the urge to fall back into my old self-injury habits. I wanted so badly for my physical pain to match my emotional pain, and if I wanted so badly We went to bed and we cried some more. We both took an Ambien and tried to sleep.

The next day, which was yesterday, I woke up and the feelings washed over me again. I rolled over and told Ken how much I didn't want to do this. He agreed. All we could say was a variation on, "This is awful and I hate it." I emailed the dean of students at my school and told her what had happened and that I would like to reschedule my exam that was slated for Friday. She got back to me, apologized profusely, and said that it wouldn't be a problem. We got dressed. I was weirdly particular about what I wore. I didn't want to wear anything that would routinely remind me of "that day I had a D&C". I thought about bringing headphones so I wouldn't have to listen to anything going on, but anything I listened to would have probably been tainted forever, and if Ken had to listen, then I had to listen, too. He ate, I didn't. I was too nauseated and was afraid I'd throw up all over the doctor. I took 600 mg of ibuprofen and 0.5 mg of Xanax. I threw the rest of the bottle of Xanax in my purse, and I was not afraid to use it. He drove us to the office in a light snow. People were texting me messages of love and support. My therapist texted me and said she was thinking of me. I turned off my phone. When we parked, we sat in silence and then said, "Let's get this over with." We went inside and checked in, and I sat in the waiting room and tried not to awkward sob among all of these women with their pregnant bellies and tiny babies. Ken held me, and I think he was actually holding me up at this point.

The medical assistant called me back and took my vitals. She asked if I was in any pain. I said, no, not physical pain. She touched my arm and tried to comfort me. We read and signed a consent detailing all of the things that would be happening, and all of the risks. I wanted to rip up the consent and throw it on the floor. I wanted to scream that no, I didn't want my uterus scraped out, I wanted my baby to be okay. Instead, I signed the consent and got undressed. Dr. T came in and explained everything that would be happening. She was kind, she was as gentle as she could be. Ken held my hands and never looked away from me. I was afraid I was crushing his fingers. Every time Dr. T heard me make make a noise in pain, she asked what I was feeling. She worked as quickly as possible. The physical pain was tolerable, minus the moment she put a clamp on my cervix to stabilize it and I thought she was going to have to peel me off the ceiling. The emotional pain was a completely different animal. It was the worst ten minutes of my life. It felt like forever. I wanted to die right then and there.

But I didn't die. It ended and I got cleaned up and Ken and I cried and blew our noses on paper towels, because for some stupid reason, there weren't any tissues in the room. My legs were shaking so badly that I had to sit down. I felt like the room was spinning. I guess that could have been the Xanax, but I couldn't believe that anything that had just happened had actually happened. Dr. T came back with my letter for school and sat with us for awhile. She told me how strong I had been and that I had been really good. She told me that I could take ibuprofen and to expect some bleeding, but not a lot. She apologized again. She looked me in the eye and said, "This will happen again for you. You will get pregnant. You will get through this." She created a spot in her schedule for me for a follow-up and said to call if I needed anything. We walked to the car in the snow.

Ken drove home and I called my mom. I was still kind of dopey from the Xanax, so I made dumb comments about birds flying in a "V" and the snow. We got home and I made tea and soup. We ate salads, and for some reason, they tasted like the most amazing food we had ever eaten. We watched House of Cards, because there was nothing further from our reality that we could imagine. We went upstairs and laid in bed. I read World War Z and texted people, Ken played his Nintendo DS. Eventually, we took a nap. We woke up at 8 and didn't know what to do with ourselves. Ken made his lunch for the next day, I fed the cats and gave Gershwin his medicine. We talked about what had happened that day. We held each other. We tried to do normal life things. We kind of failed, so we went to bed. We listened to the wind and the snow.

I couldn't sleep. I tossed and turned for what felt like hours. Ken slept, but fitfully. At some point, I had started crying, and he rolled over to hold me. We laid in the dark like that and eventually fell asleep. This morning, he woke to go to work and I tried to pretend that life wasn't happening. Ken asked if I wanted him to stay home, and I told him no, that I would be okay. I read a few things on my phone and went back to sleep. I woke up at 10:30 to get ready to go see Danna, and it took every ounce of strength that I had to pry myself out of bed. I didn't think that I could face the world, not today. I got dressed and drove to Philadelphia. I basically sobbed through my entire session. I needed it, though. I made an appointment for Ken and I to come back together on Monday, and for myself next Thursday. I forgot to get new checks, so I couldn't pay her. I felt stupid, but she told me that it wasn't a problem, I could pay her next week. I cried the entire way to my car and the entire way home.

I don't know what to do with myself. Grief is not linear and it has no rules. There is no manual that says, "On Day 1, you will feel exactly 37.5 ounces of pain, and on Day 5, you will feel 20.3 ounces." There is no guide for how to deal with the fact that everything hurts and every nerve is raw. There is nothing that tells me how to mourn for something that was never here, or how to grieve hope or expectations. There is nothing that makes sense. This sorrow has no bottom. I keep thinking that I've found it, and then there's another layer beneath that. In medicine, a woman's pregnancies and births are noted as "G_P_" where "G" is for gravidity (number of pregnancies) and P is for parity (pregnancies that cross the 28 week mark). On my medical record, for the rest of my life, my "G" number will be larger than my "P" number. Somehow, this is especially painful. This baby will always be our first, and we will never know what he or she was like. 

My body does not hurt. I have very little bleeding. I have been taking 600 mg of ibuprofen, which pretty much takes care of the cramping. I wish that my body hurt more. I wish that my outside matched my inside. At least physical pain would be a partial distraction from mental anguish. I wish that I could feel none of this, that I could take a pill and when I woke up, all of my feelings would be gone. Then sometimes, I wish I could feel everything at once, as if I could combine all of the grieving into one big pile and finish it quickly. But grief is not like that. The only way out is through, and I can't speed the process, no matter how much I wish that I could.

People are trying to be helpful. Friends near and far have said that we can ask for whatever we need, whenever we need. I know that I have a small village of support behind me, and open arms to hold me when I need to cry. I wish that I felt like being around people, but I also don't feel like being alone. Nothing feels right. Being outside, among all the life and movement, feels wrong. My sadness feels illigitimate because I was only 7 weeks pregnant, and I am somehow embarrassed by the failings of my body. I feel like my body betrayed me, that I can never trust it again. There is no rhyme of reason to how many "good" hours I will have before I collapse into sobs, and there is no warning about what will make it happen.

I will say that it is not helpful when people tell me about the woman they know who had 5 miscarriages, but who now has 3 beautiful children. It doesn't help when someone reminds me that at least I wasn't farther along. Any time someone says, "At least you know you can get pregnant," I want to punch them. That's about equivalent of saying, "Oh, your cat died, but at least you know there are more cats to be adopted." Our baby was not a lightbulb; I cannot simply throw this one out and replace it. They do not come in six packs; they are are not disposable. And yes, to us, it was our baby. It doesn't matter that it was 5 mm long and that its heartbeat disappeared so shortly after we saw it. This was real and I was really pregnant and we were really going to be parents and now we're not, at least not in August.

In August, we will not have a baby. We will not have a baby in September, and we probably will not have a baby in October. 2015 was supposed to be the year I became a mother. Now it is the year that I had a miscarriage and broke our hearts. 

I would apologize that this post is so depressing, but this is real and this is raw and this is the truth. Too many women and men stay silent for fear of judgment or because they don't want to depress people, but if 25-50% of pregnancies are ending like this, there has to be more people like me out there. All of my friends have been outstandingly wonderful, but Constance sent me something that really touched my heart:

It's not your fault. Sometimes bad things happen. It has nothing to do with you or Ken or someday being a mother. Sometimes, things just go wrong. That was the luckiest little blueberry in the world because it was so loved. You have so much to give, and do not let this make you afraid. You WILL get through this, it will always be a part of you, but you WILL get through this. You do not have to "move on," you do not have to leave your first pregnancy, your first child, no matter how early or how small - behind. It's part of you and that's okay. It hurts because it sucks and it sucks because it's unfair and it's unfair because it's just - random. Crying is okay, crying is good. You are so loved and your baby will be too, when it comes.

I've read that over and over to myself since Tuesday night, and every time, it makes me tear up, but it also makes me feel strong. Danna says that there is a bottom to this; that every day, something will get easier. That I will know it's ending when my anxiety returns and replaces the utter despair and agony and grief, because it means that I will be thinking forward, not looking backward. It sounds crazy, but if I could be pregnant again next week, I would do it. Sign me up, let me do this again. Perhaps biology knew what it was doing though, when it makes your body wait 4-6 weeks until you can try again. It demands that you give the grief the space it needs. It gives you time, for better or worse, to feel all of the feelings, over and over. To make new ones. To discard old ones. And then, eventually, people tell me that I will be okay. That we will be okay. 

Until then, I have to let this run its course, just like any other illness. I will stumble around as if in a fog, and someday, that fog will lift. Ken keeps me strong, and I keep him strong. We will hold each other up, and our friends will keep us afloat. Someday, I will find the bottom of this well, and then when there is nowhere else to go, I will go up.

Someday, I hope we will have joy, and someday, I hope we will be parents. For now, we have to wait and exist and grieve. Life goes on, and I will not let this make me afraid. Choosing "brave" as my word for 2015 turned out to be especially appropriate. And Ken and I will face this trial as bravely as we can, together.

- A

12 comments:

  1. I am so sorry. This is all so horrible, I can not even imagine the heartbreak you guys must be going through. The medical side of me wants to tell you that the really great thing is that you CAN get pregnant, but the woman/friend side of me grieves for this baby that you did lose. Take this time to grieve, and like you said, it will happen some day. All my love to both of you.

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  2. I am so sorry to hear this, I can't even imagine how difficult it must be. Sending lots of hope and hugs your way!

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  3. Oh, Alison. I am so heartbroken for you. I know you may not want to talk about it for awhile, but whenever you want to, or if you want to chat about literally anything else, I'm around.

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  4. I'm proud of you for writing this down. I know that it was painful, and it will be painful every time you go back and read it, but it's your story. Writing is cathartic in a lot of ways, and I am hoping so deeply that this helps you in your grief journey. Love you.

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  5. Oh friend. My heart aches for you. This is something no woman should have to go through. I know there are no right words to say but know that you are loved and I'd be happy to listen when and if you want to talk more.

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  6. I'm so sorry to hear this. My heart hurts so much for you. You are loved. You are strong. You don't have to do anything more than exist right now.

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  7. Sooo sorry, A. You are an amazing, strong, brave woman! What a lucky blueberry to have such an awesome mama. Now you have your own special blueberry angel to look out for you and Ken. Lots of love and prayers!

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  8. I am so sorry for your loss. Love, blessings and comfort are being sent to you!

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  9. I am currently going through a natural miscarriage (not by choice, the pain is horrendous...but my doctors office closed early Friday and they won't do it over the weekend). Reading this helped me a lot. Know that you are not alone. I was supposed to be a mother in November. I was supposed to be 8.5 weeks along. My baby stopped growing at 6 weeks. The heartbeat was there but slow on a Monday, then gone that same week on Friday. I feel helpless and I wish I could have had my baby, and I wish you could have had yours. I hope you will get pregnant again soon and have a healthy, sticky bean. Good luck to you.

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  10. I am so sorry for your loss. Thank you for sharing your experience so openly & honestly even though I'm sure it was hard to do. I also had a missed miscarriage at the end of 2013 and it was the most devastating and terrible experience I have ever been through. I hope we have our happy endings soon!

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