A year and a day

Yesterday felt like a day to get through. A year and a day ago I was at home, high on painkillers, and waiting for the Sea Monkeys to exit my body, which they did in a thankfully orderly fashion. I'm glad to have that day behind me. When it was happening, I didn't think that a year from then I'd be where I am now. I'm glad I didn't know. It would have only made it harder. 

So yeah, yesterday felt like a day to just make time pass so it'd be over. I bunked off work and went to IKEA. I flippin' love IKEA. I wandered slowly up and down each aisle. IKEA is a very family-full place and I felt a bit wobbly at times, but was generally soothed by the mountains of affordable Swedish midcentury modernity.

12 weeks ago I was examining a blood clot in the palm of my hand. I saw a little pale nugget in it, no bigger than a piece of arborio rice, with a dark dot in the middle. "Crap," I thought. "Doesn't look good." I was right.

I've been studying. That's the only way I know how to process anything. I recently read a rather good book on only child-dom, a collection of essays.

The first section was first-person essays on what it was like growing up as an only child. There was quite a range of experiences, as sibling'd children also have a range of experiences, stretching from loneliness to tranquility.

An interesting part was the section of essays by only children who were themselves facing the decision of how many children to have. Of the four essays, two of them spoke of the fear of having something happen to your only child.

This is something that's been clawing at my mind. I'm not proud of it. It seems kind of awful, like it's simultaneously devaluing the child you have (replaceable!) and the child you want (a backup!).  What, like children with siblings aren't mourned? But I am so very aware of the enormous state-change between being a parent of a living child and not being the parent of a living child. The loss of an only child is the loss not only of that irreplaceable person, but of the state of parenthood. I was a bit comforted to find that two of the four only children decided to have multiple children for precisely that reason.

Here's John Hodgeman, who surprised me by being not only a funny guy but a deft writer.

Like a farmer who needs children to till the soil and cannot risk having but one, so I need more than one child to lower my risk of absolute awful heartache.

To be honest, I do not know how this will work out. I, the only child, find it difficult to understand how love can be dispersed between two children. And there will be other shortages... For, yes, you will live in an apartment, and you will have to share a room.

But you will be freer to fail, as your errors will be outshadowed by Hodgmina's and vice versa. And thus you will free yourselves of the unfair burden to avoid death at all costs. By having you, unnamed male child, I have chosen to give you both less so that at the end, as point by point, the shape of our family disappears, you will not have lost everything.

-John Hodgeman

Yeah, that was pretty much enough to turn on my waterworks when I read it, and again now. He's captured something I couldn't articulate, the fragility of a family of three.

In the end, though, my decision is driven by sheer terror: I worry that something will happen to my child and having another would be the only thing that could get me through that.  I wish there were some braver, deeper, or more theoretical underpinnings behind my ultimate motivation for two, but that's what I come up with.
- Amy Richards

This quote doesn't offer me any insight, but it does make me feel less alone. I mean, these people were able to choose to have more children, and did (at least John Hodgeman did, I don't know if Amy Richards has yet).  But it's comforting to know that this is a fear shared by other parents, parents who were themselves only children. It's not the sole reason I want another child, even the major reason, but it's there and it's something I'm going to have to work out if I'm going to learn how to live comfortably with this.

It's all over but the bleedin'.

Hcg 115. Game over.  Not too surprised -- after the bleed on Thursday night, on Friday I passed something suspiciously... embryo-like.  I had this wild fantasy that maybe it was one of twins (really, self? With those betas?) but yeah, no.  Honestly, I knew it was over then.

At least the timing is actually pretty good. I'm about to go to Vegas for a week for a conference, and now I won't have to bring shots. And I can drink coffee, and take the antihistamines I've been denying myself for the past two weeks. And it is blessedly not dragging me through beta hell, meandering across and down in a laggardly fashion -- that's a damn good sharp plunge.  Almost as if I'd, you know, passed the entire sac on Friday.  So I hope that's a sign that this will be over cleanly.

If not, though, I'm going to Vegas equipped. In my cosmetics bag I have a DIY uterine evacuation kit, leftovers from the last round: misoprostol, Zofran, painkillers. If this drags on in a painful way I can take care of it quickly. I probably won't use it, but I find it incredibly comforting that I have it.

32 days later

I sort of got my period again on Sunday. It's so very, very light. Red when I wipe, otherwise nada. This is pretty much what my last one was like, and I thought it was just because it was the first one post-misoprostol. I guess not. It's not nice to have your heart sink every time you pull down your pants. I hope I'm not too broken.

Last night I dreamed that I was in a rowboat. There were lots of dogs swimming around, but I ignored them. Then a puppy¹ came paddling right up to my boat. I hauled him out of the water. He shook himself off and wriggled around and I thought "shit shit shit, I really wasn't ready to get another dog, but clearly I'm keeping this one."² I then noticed that the dog was female, not male, and was surprised.

My subconscious isn't too subtle, huh?

I am sort of conflicted about moving forward. If I try again, either I'll get pregnant or I won't. If I don't, it will hurt. If I do, then either I'll stay pregnant or I won't. If I don't, it will hurt. If I stay pregnant, either the baby will be okay or he or she won't. Etc. It's... just going to take me a little while to screw up my courage to go again.  





¹A swift google tells me that the puppy was probably a St. Bernard, possibly a Landseer Newfoundland.

²The last of our three dogs died not too long ago, and we've vowed to remain dogless for a while.

Not 11 weeks

Today I am officially precisely not 11 weeks pregnant. It's been two weeks since I took the misoprostol, three since the ultrasound where the RE said "I don't see a heartbeat".

Things are okay. I had a followup appointment two days after the misoprostol, and everything looked good and clear. That was the best I could've hoped for. My pee-sticks are still a lot darker than I'd like, but I guess it takes some women a really long time to clear out all the hCG. I can't start another cycle until my level is all the way down and I have another period, so I'm just spinnin' my wheels here. I have another followup on Friday. I imagine they'll start doing blood tests every week or two until I'm at zero.

Time floats by so aimlessly when you're unpregnant. Pregnant means that every day is an achievement, and is moving closer to Something Big. Unpregnant you're just waiting for something that may or may not happen. And if you can only conceive with fertility treatment, you're waiting to start waiting for something that may or may not happen.

I'm mostly back in the TTC mindframe (as opposed to the pregnant mindframe). I know how to do this; I've spent a lot more time trying to get pregnant than I have actually being pregnant.  But some part of me, maybe 10%, is still stunned and saying wtf happened here?  See, it all just seemed so right. The transfer was exactly on my birthday. The due date was exactly my mother's birthday. My BFF is pregnant right now, and we were going to be pregnant together. Some things are just meant to be, you know?

Some things, but apparently not this one.

A poem has been stuck in my mind: A Refusal to Mourn the Death, by Fire, of a Child in London. I don't know why. I have only a weak affinity for poetry, and almost none for Dylan Thomas; most of it just reads as word-salad to me. But this one has been drawing me back. I guess "unmourning water" is really a pretty good description of the resting place of those two tiny embryos, poor miniscule brine shrimp, released unto the municipal sewer system.

9 weeks: finding the reset button.

Today would've been 9 weeks. Last Wednesday I'd resolved to wait, zen-like, for my body to take care of this naturally, gently.

That decision lasted until the evening. I did a little research and found out that with misoprostol, it's frequently over within twelve hours. The old-fashioned way can take, literally, weeks. Weeks of bleeding, weeks of cramps, weeks of pregnancy symptoms.  I did the math (number of weeks multiplied by insanity factor) and by the next morning was super-keen to get the misoprostol.

Except it turns out that the misoprostol I was offered so lightly on Wednesday night was actually a pain in the butt to get. I called Thursday morning, with some idea that I could stop by the office on Thursday afternoon to get the prescription. Hahaha no.

I finally got a call back Thursday night telling me that someone would call me Friday morning. On Friday morning, the PA called and said she'd talk to the doctor and get back to me later in the day. At 5 pm she called me back and said "you'll have to come in for an appointment on Monday."  I'd dreamed that I'd be able get it all over with by the end of the weekend, and was bitterly disappointed to be denied.

Anyway, I dragged through the weekend -- I say "dragged" just because the pregnancy-fatigue was still going strong, along with the need to get up and eat a three-course meal at 2 am every night. Pregnancy symptoms are a lot of fun when you're going to have a baby. They're just an annoying inconvenience when you're not.

Monday morning I went in for my appointment. They'd mixed up the paperwork and had me down for an ultrasound even though I was only supposed to be there for a consultation. "What the heck," thought I. And maybe, just a little, maybe .05% of my brain thought what if it's all a mistake? What if it's a Christmas miracle? What if there's a little heart beating away in there?

There wasn't. There were two little embryos, measuring 6w2d and 7w4d, clearly sharing a placenta (i.e., identical). They looked like little packing peanuts curled up in there, two very quiet packing peanuts. I kind of wish I'd gotten a picture, but for some reason they don't offer you pictures of the dead ones. But in any case, I was still glad to have seen them again. Last week I hadn't gotten a measurement for Little Twin, so it was oddly satisfying to have that verified. 

The doctor's not a big fan of misoprostol. He gave a decent shot at trying to convince me to do a D&C. He assured me that they're "very gentle" and that they "only use suction" and "the chances of getting scars from a correctly-done D&C are almost nil". If I did a D&C it would all be over quickly. If I did a D&C I could have a chromosomal analysis done of the tissue. With misoprostol, 40% of women have to have a D&C anyway.

Unfortunately, I know that most of what he was telling me wasn't true. Don't get me wrong, I think this practice is very good at what they do, which is reproductive endocrinology. They don't know jack shit about Asherman's Syndrome. Yes, you can get adhesions from a properly-done D&C. No, using suction only doesn't prevent scarring.  No, a woman with Asherman's shouldn't get a D&C done unless there is absolutely no alternative. Misoprostol is more than 80% effective if you give it a whole week to do its work (this practice judges after three days).  I'm a walking dictionary of misoprostol trivia at this point. I spewed some figures and he sniffed and shrugged and said he'd go to get the consents.

He left, and then I cried. I wasn't really expecting there to be a living baby in there.  But seeing the pictures was still... hard. Little Twin was pretty indistinct, but Big Twin looked like such a perfect little fetus. Perfect, just dead.

I spent the next three hours getting my blood drawn (they require a hematocrit), waiting for the bloodwork to come back, waiting for this, waiting for that, waiting at the pharmacy. It was, apparently, lovely weather for a sleighride together with me. Also, I should have myself a merry little Christmas, and that's the Jingle Bell Rock. I did not stab anyone.

Four hours later I emerged with 8 200mg tablets of misoprostol, a strip of Zofran (anti-nausea), and a handful of Ativan, I guess in case the process made me edgy? I'd already filled a prescription for some painkillers.

I decided to wait until Wednesday morning. Misoprostol can be unpredictable, and if I were going to be doubled over/vomiting/yelling/cursing/hemorrhaging, I wanted it to happen when Small Boy was at preschool and not when the poor dude was trying to have himself a Merry Little Christmas.

So yeah. This morning I dropped him at preschool, went to the supermarket and picked up a party-sized pack of sanitary napkins. Went home, popped a Zofran and a Perc. Half an hour later I briefly dipped the misoprostol pills in 5% acetic acid, better known as white vinegar, and crammed four of them up the hatch (via my handy PreSeed applicator). I then waited for something to Happen.

An hour later I started cramping. Four hours later I felt like something was going to Happen. I shuffled over to the bathroom and then in a mighty rush, the entire universe fell out of my uterus.  In the space of five minutes I passed the gestational sac, the fetuses, and what Her Indoors was sure was at least some of the placenta (she's a biologist, so I have some faith in her identification).

Friends, that is some good stuff. I know everyone is not as lucky. Some women end up writhing and puking, and some women get no effect at all. But for me, it did exactly what it said on the tin. The cramping has been no worse than bad period cramps (admittedly, without the painkiller it probably would've been a whole lot worse). And holy god has it cleared a lot of underbrush out very quickly.

I've been bleeding briskly since this morning. The cramps have gotten better and worse, but the painkillers keep them bearable.  I won't know until Friday if the job's completely done. If it's not I'll likely have to fight not to have them "clean it up" with a D&C. But fight I will; if anything lingers, you bet I'd rather have another round of misoprostol.

Right now I feel wrung-out and crampy but so relieved, and grateful that the misoprostol seems to have worked for me. Fingers crossed that Friday finds that it truly is over.


¹The literature is a bit mixed on whether or not dipping the pills in acetic acid definitely speeds action/improves absorption. But I figured I'd try it on the grounds that at worst it would have no effect, and at best some studies have found it halving the time to completion (which otherwise averages about 12 hrs from administration). Since my uterus enthusiastically spewed four hours after inserting the tablets, I'm inclined to believe that it helped. It also makes a lot of intuitive sense to me. As soon as I dipped them they started to disintegrate. I was basically inserting a firm paste, not dry pills.  If any internet travelers stumble across this, I personally vote "yes" on dipping in 5% white vinegar.