I've started feeling strange abdominal cramps. I'm worried that something is going wrong. Obsessing about my uterus was a useful distraction, at least, from the horrible movie Paul and I went to see tonight. (Not even the delectably pockmarked Jet Li could save it, and I normally like the hitting.)
For the record, I refuse to believe it has anything to do with helping Paul move lumber yesterday. I keep chanting to myself, "Slave women gave birth in the fields and kept on working." I, cream puff that I am, need not worry about overexertion.
Aside from the sore breasts I've had since I began the progesterone suppositories, I had my first symptom of pregnancy tonight at the movie. Paul unwrapped a chocolate bar and the smell of it was so intense I had to get him to re-wrap it. It felt like an assault. It didn't make me feel sick, but, wow, sensory overload from a whiff of chocolate. Since then, I have noticed that everything smells like cigarettes. Some women get a lush new rack. Some women get lovely skin. I get a full pack of Camels crammed right up my nose. Thanks.
If something is wrong, there is, of course, nothing to be done. Third beta is tomorrow.
Fat lady, you're wanted onstage.
The news isn't good. My third beta rose from 226 on Wednesday to...269 today.
Dismal, dismal, dismal.
I've been asked to return on Monday for yet another beta. The nurse presented three possibilities:
- a failing pregnancy;
- an ectopic pregnancy; or
- a meaningless statistical blip in an otherwise healthy pregnancy.
That Hallmark moment
My beta went up, so theoretically I'm still pregnant. And shocked to the core.
It increased from 269 on Friday to 713 on Monday — that's a 63% two-day rise.
Now the Internet, blessed fertility oracle that it is, tells me that's adequate, although certainly not ideal. (And getting medical advice from the Internet has proven so far to be a great idea.) But after our two-day stall last week, I refuse to get too excited.
Seems like I've been refusing to get too excited for weeks now. I was quietly smug after the first beta, cautiously optimistic after the second, and solidly grounded in determined pessimism by the third.
Goddamn it, I completely missed that Hallmark rush of elation. You know, the one where I present Paul with, I don't know, a tiny pair of booties and he looks bewildered for a minute, then breaks into a smile whose brightness rivals the sun. And then he lays his hand lovingly against my still-flat belly (not that it's flat to begin with, but this is my fantasy), and speaks in a hushed tone of wonder and says...
I have lost my mind entirely. See, I told you this whole thing fucks you up good. To be fair, we're not exactly Hallmark people to begin with.
I'm scheduled for a scan early Friday morning to see what's going on. By then my hCG levels should have risen, if they're going to, to about 1,200 — that's right around the discriminatory level for seeing a sac with transvaginal ultrasound. First we want to see a sac in the right place. Then, though I don't really dare to hope, we want it to be the right size.
Until then, I will be working very hard to will a comely little sac into existence.
Relatively good, absolutely bad
The good news is that we saw a gestational sac via ultrasound today. The bad news is that it's much smaller than it should be at this point. (It should be at 10 mm by now, and mine is only 5.)
So the good news is only relatively good: it just means that we can pretty much rule out an ectopic. Indeed, the doctor stirred the ultrasound wand enough to check out my tubes and ovaries, and they appear to be normal, with no fluid masses.
The bad news, however, remains absolutely bad. This is not a viable pregnancy. I asked my doctor if the sac could somehow catch up to where it needed to be. Because he is a kind man, he gave the appearance of considering it, but finally had to say, "I would be shocked."
This is what we expected to hear after the appalling lag last week in my hCG levels. But expecting bad news doesn't make it any easier to take when it's delivered at last; it just makes it easier not to look like you've been kicked in the gut.
Denial is a lovely name for a girl
This is the worst mindfuck I've ever had. I know my pregnancy isn't viable. I've seen the evidence myself on ultrasound. I've left no electronic stone unturned on my Internet quest for a single piece of research that could prove the ultrasound wrong. I've found nothing. I know it's over.
So why did I dream last night that we had a baby girl whose name was Lucy?
The best of three bad choices
A miracle did not occur. We were not surprised.
Today's ultrasound showed that the gestational sac had grown, but it was still about a week behind where it needed to be, with no yolk sac, no fetal pole, and obviously no heartbeat. If you don't have most of those things at 6 weeks 5 days, you're just not going to get them.
It confirmed what we already knew. I felt a dull sadness, a background version of the more turbulent feelings I've been having for about two weeks now.
My doctor offered three options.
I could wait to miscarry naturally. As far as I was concerned, this wasn't an option. On the one hand, you know beyond a doubt that the pregnancy is really and truly over. On the other, that could take weeks, and could happen in the supermarket checkout line. At this point, haven't we gone through enough without imposing more uncertainty on ourselves?
I could have a D&C. I briefly considered this, but decided I'd like to avoid that if possible. I worried about the pain of the procedure, and I worried that I'd have to wait for an appointment. I wanted it over.
I could take misoprostol, a drug that induces miscarriage. (It's usually used in conjunction with mifepristone, but in IVF patients the other drug is unnecessary.) It's taken vaginally, and it causes your cervix to soften and dilate; the ensuing contractions usually empty your uterus of the products of conception.
I decided on the misoprostol because it will cause a predictable miscarriage that I can endure at home, properly medicated, without surprises. I'll be inserting the tablets tomorrow, after which I intend to spend the weekend feeling hideously, operatically sorry for myself.
I took the misoprostol yesterday as directed. I put it in around 8 AM and sat down to wait for my uterus to explode.
And pretty much wasted the entire day just waiting to feel something. Finally around 5 PM I started feeling some gentle cramping. Because I thought the festivities were beginning in earnest, I girded my loins with the thickest maxi-pad I could find, dosed myself with Tylenol 3, and stationed myself on the sofa.
Now I grudgingly concede that my vagina and what eventually issued forth are not of interest to everyone. Skip the next part unless you really want to know.
At long last the cramping grew stronger. At around 10 PM I began to pass some gelatinous fragments of grayish-looking tissue. There was never a lot of it, and very little bleeding. In fact, there was no red blood; I had only occasional scant dark brown spotting.
I found this disconcerting, as I'd expected to be floundering in a pool of my own blood by now. (First time in my life I actually hoped to see blood.) But I cheered up a bit once I decided I would probably wake up in the middle of the night having soaked through the sheet, lying in a pool of my own gore. I went to sleep with high hopes.
And woke up this morning lying in nothing more than a lighly spotted maxi pad.
The dark spotting has continued, but I still haven't seen a single drop of red blood, and since last night I've passed no more of the grayish matter.
I hope I'm wrong, but I'm not convinced it's over yet.
I liked it so much I did it again.
I went back today to get my blood hCG levels checked after Thursday's dose of misoprostol. My doctor saw me in the waiting room and took me aside to ask me how it had gone. When I told him that it was mostly unproductive, he furrowed his brow and suggested an ultrasound. Why not? It had been days since I'd been romanced by a cold piece of medical equipment. A girl could start to feel neglected.
Sure enough, half of the sac was still there. He said I would probably pass that on my own if I was willing to wait, but he didn't seem surprised when I said I was eager to get it over with.
The weeks without a resolution have been excruciating. From the day of my second beta test, I've worried; from the day of my third I've known this wasn't a viable pregnancy. At this point, I'm in favor of anything that will hasten the end of this discouraging cycle.
On the way home, I stopped and picked up three large Symphony bars, a giant bag of potato chips, and a fifth of vodka. (A girl needs her medicine.) When I got home I inserted the tablets as before and sat down to wait for my insides to fall out.
I didn't have long to wait. This time it took effect more quickly. Within three or four hours I was having some fairly strong cramps. Now I'm having some spotting, some bright red blood instead of the dark sludgy stuff of last time. I have taken to the sofa and I will not budge until it's over, or until I need more chocolate, whichever comes first.
I can't even do this right
I don't believe it worked.
I bled some during the night, but not enough to convince me this is over yet.
I have yet another hCG test scheduled for Friday...my eighth, I believe. I am thinking of having a convenient grommet installed in the crook of my elbow for easy withdrawal.
Third time's the charm
I went in today for more bloodwork to confirm that the second dose of misoprostol worked. I had my doubts, as I'd finally had some bleeding, but not as much as you'd expect from a real live miscarriage. (I'd sort of expected to wake up the next morning with HELTER SKELTER painted on the wall in blood.) As I waited to be taken back for the blood draw, my doctor breezed past the waiting room, saw me, wheeled back cartoon-style, and took me aside to ask me how it had gone.
I told him what had happened, and what hadn't, and he seemed nonplussed. I had no ultrasound scheduled, but before I knew it, there I was, naked from the waist down and impaled on a probe. (Hello to you, too.)
What we saw was not encouraging. The remains of the sac were still there, the same size they'd been on Monday. "Want me to just get it out?" he asked.
"God, yes," I said.
A harrowing description of my cervix being wrenched open follows. You've been warned.
I gave my blood for the hCG test, took a couple of Vioxx, and waited for them to take effect. I asked for a sheet because I was cold. "I'm not cold," said the doctor. "Are you cold?" he asked the nurse. "No," she answered. "In fact, it's kind of warm in here."
"See, the thing is," I pointed out reasonably, "you're wearing pants." A sheet was produced with alacrity.
Shortly thereafter, the doctor and nurse collected their tool kit and got down to business. Speculum: check. Cervix swabbed with iodine: check. Panic attack held valiantly at bay: check.
"Okay, first I need to see where your cervix goes," the doctor told me. "Everywhere I do," I answered. Oh, how we all did laugh. Discuss among yourselves this question: why must I try so hard to be entertaining?
"Now I'm going to attach a grasper to your cervix to open it up," he said, and I was instructed to cough. It took him three tries to get a firm grip on my recalcitrant cervix.
"Grasper," I said, when I'd caught my breath.
"Yeah," he said. "It sounds less threatening than tenaculum."
And then things stopped being funny. I was given a local anaesthetic — lidocaine, I believe — and he waited a moment for it to take effect. Then the nurse, a real sweetheart, came to stand beside me, held my hand tightly, and said, "This is going to hurt, for only about 30 seconds."
Finally the doctor said, "That's got it." He and his nurse were quick, efficient, and as gentle as they could be under the circumstances. And they did a first-rate job of not letting me see any of the implements used or the so-called products of conception. (I know I would have looked. I don't think it would have bothered me, but I can't really know.)
My uterus continued to cramp for several minutes, so I lay quietly on the table under my hard-won sheet. The nurse brought some water, which I didn't want but drank. Another nurse came to check on me in a few minutes, and assured me that I could stay as long as I needed to. In about 15 minutes I was on my way home.
I guess I can't complain. It's not like I had a co-pay or anything.