There Will Be Blood Clots

Remind me not to schedule my next genetic counseling and ultrasound appointment on any sort of major or minor holiday. The first ultrasound of doom came April Fool’s Day. The second came last Tuesday on the first day of Rosh Hashanah. L’shana tova my ass.

Our second trip to the OHSU Center for Health and Healing or as we are now calling it the Center for Disappointment and Sadness begins with enough promise. The sun bounces off the windows of the Streetcar that take us to our appointment. Sara, our genetic counselor, greets us with smiles and congratulations, also a cute new blonde hair color. I say a silent vow to get my highlights re-highlighted as soon as possible. The trimester of safety and sickness concludes in one week. I can’t wait to check out the dimensions of the 2nd trimester, the best trimester. Pregnancy only means nausea, exhaustion, and sore boobs to me at this point.

“It must be strange coming back here,” Sara says, gesturing for us to sit down in the chairs where 6 months ago we had cried and learned what the terms “molar pregnancy” and “missed abortion” meant. Sara gave us tissues and cups of water to take on our return trip to work that day. I remember the details of the room as if I had been here yesterday—the brushed metal mini-refrigerator, the stacks of tissue boxes on metal shelves, the notebook with graphic representations of genes and lists of occurrences of Down Syndrome by maternal age sprawled on the table.

“Yeah,” I say. “It’s kind of traumatic.” I laugh nervously and sniff away tears.
She takes a seat across from us. “We have no reason to believe that what happened before will happen again.” We nod solemnly.

Briefly we review the tutorial of sequential screening that she had given us 6 months ago. We have no questions. She sends us off to kill time before the ultrasound as the technician is running almost an hour behind schedule.

“You’d think after the last time they wouldn’t make us wait,” I say as we step into the elevator.

“At least we can leave.”

Mr. Crud and I step into the cool fall afternoon. “Those 15 minutes cost us $204,” I say.

“Really?”

“Genetic counseling isn’t covered for some reason even though it seems like it would cost the insurance company less to do non-invasive testing first.”

“Fucked up,” Mr. Crud says.

We walk to a private beach on the South Waterfront. Signs warning us of private property abound but residents are scarce. The slowdown in condo sales has been especially cruel to this burgeoning area. We spy a group of yarmulke-topped heads around a table in one of the glass window condo boxes.

“L’shana tova?” I say and look to Mr. Crud for affirmation.

“That’s right.”

Slowly but surely I am learning my Jewish holiday greetings. I am all over Hanukkah and working on my Rosh Hashanah and Passover. Haven’t quite made it to Yom Kippur but I know that I’m supposed to be somber and wish folks an easy fast.

We find a bench and share a blueberry muffin lest the ever-lurking nausea get me in its grips during a key moment of our appointment. This could me my last hour as a pregnant woman, I think. Despite my uneasy détente with the worried voices in my head that this pregnancy isn’t going as well as everyone believes, I still can’t help planning for a bad outcome. I did the same before our first ultrasound at 8 weeks, writing out the speech I’d tell my boss in my head as the doctor smiled and directed our eyes to the fluttering heartbeat on the screen.

Some of the internet boards and well-meaning friends suggest that even allowing such negative thoughts to exist creates a danger to my pregnancy. With all due respect, I think not. My friend Angela had 2 miscarriages between the births of her 2 daughters and she didn’t stop worrying the entire time she was pregnant with her second daughter…which didn’t make her youngest daughter any less real or healthy.

“I barely believed she was real after she had been born,” my friend said, assuring me that my worry was nothing to worry about.

Please people, stop telling pregnant women not to worry, to focus on the positive and implying that worrying is the reason for their miscarriages or infertility. If negative thoughts could end pregnancies, there would be no need for abortion or for women with unwanted pregnancies to worry about ending their pregnancies: “Yeah, I’m knocked up again but I’ll just tell the little fucker to scram and that ought to do the trick.” I can see this opening up a whole new unsavory can of women’s rights worms.

Sometimes I feel like I have to defend my right to feel a little anxious about being pregnant after a miscarriage. For the most part I’ve remained calm and positive although I’ve had moments of fear and worry. I think that being honest about my fears, experiencing them and letting them go is healthier than denying them. Denial leads to a heap of shrill voices that come screaming at me at 3 in the morning, commanding to be heard.

A few minutes before our rescheduled appointment time we head back to the ultrasound office. Here we wait for another 45 minutes as the doctor apologetically explains that the person before us is pregnant with triplets.

“I hope everything is okay,” I said.

Mr. Crud nods.

Finally the doctor ushers us into the room of my nightmares. The framed pictures of Audrey Hepburn and Meryl Streep gaze upon me as I hike down my pants and underwear in preparation for the squirt of jelly on my belly.

Mr. Crud has requested that a doctor sit in on the ultrasound so that if anything is wrong we won’t have the agonizing wait, so that we won’t have to hear the words “I’m not seeing what I’m expecting here. Let me get the doctor” again.

Dr. Toloso is the doctor of the day and he willingly agrees to come along on our second ultrasound voyage. He explains what will be happening, the possible meanings of what they might see, and also reassures us that even if they cannot see well with the stomach cam that the vaginal cam does not automatically mean that we are doomed.

“I know you are very nervous, Katherine. We’ll do this as quickly as possible,” he says with a charming accent.

The technician, Chrissy who is different than the Chris of last time’s ultrasound, pushes the wand around my belly, and presses buttons that emit a beeping sound from the machine. I stare at the ceiling as tears stream down my face. After a few seconds I know. It’s happening again. This is how it happens.

Dr. Toloso tells me that a vaginal ultrasound is necessary. He instructs me to empty my bladder. Numb, I walk across the hall and pee. So distracted am I that I leave the bathroom door wide open and don’t give even the tiniest of shits.

Mr. Crud and I hug before I undress. “He said this doesn’t necessarily mean anything bad,” Mr. Crud says.

The tears keep coming. I take off my pants and stick my feet in the stirrups. Dr. Toloso and Chrissy return. The probe goes in and the wand wiggling and beeping recommence. Dr. Toloso asks questions as he watches the screen:

Are you still experiencing symptoms?
When was your last ultrasound?
Have you experienced any cramping?

The charade is up shortly thereafter. “Katherine, I’m sorry to tell you that things are not going well.”

It appears the newest Peabody incarnation, who I have named Dewey (close to the Italian word for Due, meaning 2), died shortly after the first ultrasound which revealed the heartbeat, around 8 weeks. My clingy uterus is at it again.

“But why didn’t I just have a miscarriage?” I ask Dr. Toloso. “Why didn’t my body get rid of it?”

Next to the whole having a miscarriage thing, this bothers me the most. Why in the fuck does my body not know when the thing it is carrying around inside of it dies? Why must I become a walking casket?

“You would have eventually had a miscarriage,” Dr. Toloso says.

The pregnancy loss counselor who we saw after MC#1 said the same thing. I don’t find it comforting. My uterus does not know when to let go, when to say good-bye to the squatter. My 13-year-old-girl hopeful uterus: If I just keep pretending, maybe it will be true. Sorry, kid. Carl Perry wasn’t secretly falling in love with you during 8th grade gym class and this pregnancy ain’t happening.

Dr. Toloso tells me to get dressed and that he will be back and we can discuss my options. I need no discussion. “I want a D and C with Dr. Bednarek tomorrow morning or as soon as possible.” I know my way around the missed abortion block and the one thing I know for sure is I don’t want this dead embryo floating around inside of my uterus and making me feel tired and nauseous another moment more. Strangely enough, my pregnancy symptoms disappear after I get the news. Suddenly I am wide awake and the nausea vanishes. Great, now my brain is in on it too, tricking me into thinking I’m pregnant with well-placed dry heaves and cravings for cheese.

Dr. Toloso leaves to make the arrangements for abortion #2 as I get dressed. Mr. Crud and I hug and cry. “Why is this happening?” Mr. Crud asks.

“This happens to a lot of people,” I say. This comforts me for about 2 seconds.

Nobody knows why it’s happening. Not Dr. Toloso nor Dr. Bednarek or Dr. Risser. Dr. Toloso offers us tests after we have recovered from this latest chapter of doomed pregnancy. Dr. Bednarek assures us—although I don’t remember as I got so high on Ativan that I saw double—that we will have a child. Dr. Bednarek’s resident reminds me that medically recurrent miscarriages aren’t considered a problem until a woman has three in a row. We may want to reconsider doing the tests at this point, she says. Mr. Crud wants to do the tests. He worries that the miscarriages are somehow his fault. Even though we are assured and reassured that the miscarriages are nobody’s fault, the both of us take the blame. I murmur angry curses at my uterus, my vagina, my still overgrown pregnant boobs. I know that this isn’t helpful but the words slip out. “Go the fuck away,” I say to my boobs as I wrestle them into my too-small bra. “Nobody needs you anymore.”

The D and C goes about the same as the last time although we have traded the large operating-type room for a cramped examination room (for a savings of $1200!). The tall awesome nurse, Lisa, from the last time brings me my drugs and checks on us after the procedure is done. We talk books and again I am frustrated at how I trip over my words under the influence of anti-anxiety meds. She tells me that I am known as the “Cool Boot Woman” around the OHSU Women’s Health Center. Dr. Bednarek rushed out to buy the same pair of turquoise cowboy boots that I wore to my first D and C. Another resident picked up a pair in lime green. Consumer desire grips me. I want lime green! I vow to myself to go on a mission during my days off of work. Glimmering green boots pull me out of the gathering funk…for about 3 seconds.

All maxi-padded up, Mr. Crud and I head home where I wolf down a smoke salmon bagel and spend the rest of the day snoozing on the couch.

I decide to stay home from work the rest of the week. My days are spent checking the maxi pads for overly large blood clots and crying. My boss is awesome, telling me that they’ll survive without me at work even though it is the first week of fall term, arguably the busiest days of the year. Mr. Crud stays home when he can and we fall into each other’s arms at double the rate of our normal hugging schedule.

I bleed.

I bleed some more.

I contemplate my membership in a new sisterhood: the recurrent miscarriage club. After the first miscarriage, I hoped that I would never see the dimensions of this new clubhouse: the “Why me?” wallpaper and red hot anger blasting from the furnace. “Most women only have one miscarriage,” the websites, doctors, and books assured. Most then added a statement about how most women who have more than one miscarriage eventually go on to have a successful pregnancy. How big is eventually? 2 miscarriages? 7? My friend Angela decided that she could have 7 miscarriages before throwing in the childbearing towel. “I saw some statistic that 80% if women who have miscarriages have a successful pregnancy.” I no longer find comfort in statistics. My latest pregnancy had a less than 13% chance of miscarriage. I’m beating the odds. Hooray for special me.

Sunday morning I am awoken by killer cramps that only 2 Vicodin chase away. Do these count as severe cramps? Should I call the doctor? That afternoon I stand up from my fetal position to use the bathroom and a huge clump—though not larger than the egg the pamphlet warns me to look for—passes through me onto the pad. I sit on the toilet and hyperventilate. This is so fucking gross. I want to call Mr. Crud in to share in the gore. It’s almost fascinating. The miracle of death and all that, but I spare him and wrap it up in a plastic grocery bag. I jam it deep into the trashcan. I curse maxi-pad world.

The rest of the day is a blur of bloody pads, cramps, and Mr. Crud bearing mugs of Peppermint tea. I dread returning to work the next day although I don’t feel as tortured by the question of to tell the coworkers or not to tell. I decide against making the grand email announcement that I did last time. One miscarriage is sad; the second one seems careless. My coworkers are great, but I loathe the looks of pity that I received. Most people don’t know dick about miscarriage and my attempts at education must come through sniffles and tears that I don’t have the time or energy to shed this time around.

I email the friends who I had let into the pregnancy world. The sorry-s and why-s come fast and furious. Each kind word brings fresh tears. Even though this sucks harder than almost anything I’ve been through, I am overcome with gratitude for my friends and family and their expressions of kindness: a quiche dinner with Tracy and Ezra while their 8-month-old paddles around the floor; a care package from Dan and Anna with a note that makes me ache to hug them; Dawn and Eric bringing us out of our mourning bubble with a dinner at the Savoy, phone calls and emails and enough love to make me feel lucky instead of unlucky. I play my usual misery game and think of those who are alone, who can’t find comfort with loved ones. So many more suffer more than this on a daily basis.

I get an email from a yoga pal who asks why I’ve been away for a week. I share the news even though I hadn’t told her of my pregnancy. She tells me that she experienced her second miscarriage during the summer. She and her husband found answers at a local fertility clinic. I google immediately.

I feel weird doing all the tests like we are trying too hard for a biological baby. I didn’t think I would be one of those women who would do anything for a baby born of her materials. Mr. Crud and I have already discussed adoption. At first I didn’t think I’d ever want this, but I’m warming to the idea. I think adoption is awesome in theory and I love to see multi-ethnic families roaming the neighborhood. However I never fail to think about the couple’s struggles with infertility or miscarriages. Now I puzzle over their back story. I cringe to think that somebody would do the same to us. (Insert speech to self about how I need to stop caring so much about what other people think.)

For the time being I have no answers. Just an ever-multiplying stable of questions. One thing I know for sure: I really REALLY want a dog now.