You reproduce I'm bitter.
If all goes according to my diabolical plan and my hCG level drops as expected, it should return to 0 around the end of this month. If I ovulate two weeks later, I should get my period sometime in mid-May. This means I could possibly do another IVF cycle in June.
I feel myself getting hopeful for the first time in weeks. And then I think, Wait. So far nothing's gone according to plan. Why in the world would it start now?
It's hard enough to come to terms with the loss of potential. (I don't even really think of it as the loss of a child — I'm not sure I'd dared to think in those terms.) What's almost as difficult is resigning myself to the loss of hope.
I don't mean I think it's hopeless for us to attempt IVF again, or that our hopes of becoming parents are forever dashed. Nothing that melodramatic or final. I mean that I don't think I can approach another pregnancy, or even another IVF cycle, with the same optimism I felt before.
The day I had my first beta test, I talked to my friend T. on the phone. T. has two gorgeous children, the result of two effortless conceptions and two uneventful pregnancies. I suppose I was pretty low-key about it, because she asked, "Aren't you excited?"
I told her, "Until I see that the second number doubles, I'll be hopeful, but cautious."
She said, "I can't imagine that. As soon as I saw those two pink lines I was choosing names and decorating the nursery."
It seems that infertility changes your whole frame of reference. Losing a pregnancy shifts it just as drastically. I didn't have that luxury, that heedless joy, in my first pregnancy. How cautious will I feel during the next one?
After three attempts to end this once and for all, I am still pregnant. Only today, 8 weeks and 3 days after my egg retrieval, was I finally diagnosed with an ectopic.
The doctor's office called and said the pathologist found no chorionic villi in the tissue removed during my D&C. We weren't sure whether I'd passed it during my earlier miscarriages (and how strange is it to make that plural?), or whether it was a more ominous sign, so I went in for bloodwork to make sure my hCG levels had decreased as expected.
Well, they hadn't. In fact, they'd risen — a pretty clear indication of an ectopic pregnancy. Why didn't we know this earlier? I blame society.
No, wait. I blame the pseudosac.
Apparently, in 10 to 20% of ectopic pregnancies, a pseudosac is formed in the uterus, mimicking the appearance of a real gestational sac. I don't know why a pseudosac sometimes develops. Who the hell does it think it's fooling?
In my case, the sac we saw on ultrasound looked like an early intrauterine pregnancy — just one that was far behind where it should have been in size.
As to why this wasn't detected sooner, I can only assume it can be hard to tell the difference. Either you can wait for the development of a yolk sac and a fetal pole to be sure it's a true sac, or an ultrasound can show the characteristic double ring (known as the double decidual sign).
My doctor pored over the ultrasound films and determined that it looked like a real live sac. Because I was eager to move on, we didn't spend any more time waiting for a yolk sac to develop. We concluded it was simply a non-viable uterine pregnancy, and acted accordingly.
What can I say? Mistakes were made.
I've had attentive followup care; otherwise the situation could have become dangerous. I have some mild symptoms (cramps, bleeding), but I would have ignored them because they're also what you'd expect after a D&C.
I go in tomorrow for a shot of methotrexate, which should arrest the growth of the pregnancy, allowing my body to resorb or jettison the remaining tissue. After working so hard to achieve a pregnancy, I never imagined I'd be working just as hard to end one.
After a quick detour for still more bloodwork, I went in today for the aforementioned methotrexate injection. Now, methotrexate works by interfering with rapidly growing and dividing cells — i.e., an embryo. Or a tumor.
That's right. Methotrexate is used to treat cancer. The pharmacy gives you the medicine in this big lightproof bag with fluorescent stickers all over it: "CAUTION: CHEMOTHERAPY!" and "DO NOT HANDLE WITHOUT PROTECTIVE CLOTHING." It makes you want to use tongs and gloves just to carry the bag back up to the nurse (who then dons a disposable gown, gloves, and fetching plastic cap, of course).
It seems like a scary drug, but apparently it's very successful in treating unruptured ectopic pregnancies. About one patient in 20 will still require surgery, but I have no intention of being among those ruptured few.
The injection itself was uneventful. I was given a stern talking-to about the absolute necessity of follow-up bloodwork on a weekly basis, and a long list of things I must not do:
She used to seem so sane
I spent a lot of last night convinced — for no good reason — that I was going to die. I wasn't really prepared for the horrible cramping the methotrexate would cause, and I was sure it was a precursor to the "sharp, stabbing pain" all the Web sites promise upon a rupture.
My anxiety level wasn't exactly flatlining to begin with. My doctor called this morning to check in, and I think I must have sounded suspicious when he identified himself, because he hastened to assure me that he didn't have any bad news.
"You can't really blame me for being afraid another shoe's going to drop," I told him. Last night when I was panicking about the pain, I realized that I really have come to expect bad things to happen. I've been on the freaky side of the odds the whole way, really, and it's hard to believe anything will change. One patient in 20 will still need surgery after the methotrexate; with my track record, I wouldn't bet against it. I've already packed my goddamn toothbrush.
I asked him how long we'd have to wait after the resolution of the ectopic to do another cycle, if we'd need to wait longer to recover. "You mean for your sanity?" he asked, not getting it.
Sanity? Long gone. I'd have thought he'd know that; surely I'm crazy even to be considering another cycle. Last night was iron-clad proof that I've lost it entirely.
I sat quietly in the kitchen while Paul made dinner, not helping because I was sure I'd felt light-headed. I told him I hoped I didn't progress into dizziness, then wondered anxiously whether light-headedness and dizziness were the same thing.
I obsessed aloud for a full 10 minutes about where the tips of my shoulder are — one symptom of a ruptured tube is "pain in the shoulder tips," but how could I know whether I had it if I couldn't figure out what the hell a shoulder tip was? Paul's wise approach: "Are your shoulders hurting at all?"
"No," I admitted sulkily.
"Then you probably don't have to worry about shoulder tip pain."
It took me a very long time to go to sleep because I was afraid I wouldn't wake up, that my tube would rupture in the night and I'd bleed to death without being awakened by the pain. I cried for a little while as Paul snored beside me, thinking about how sad it would be for him to find me lying lifeless in our bed.
How embarrassing when I woke up the next morning not dead after all.
Sunday, bloody Sunday
Every time I go to the bathroom, it's like I'm visiting my own murder scene.
I am shocked to be bleeding this much. I started bleeding after my D&C more than a week ago and haven't stopped since. It wasn't clear where the D&C bleeding stopped (if it ever did) and where the ectopic bleeding started (if it has). There's certainly been a qualitative change in the bleeding, though.
I am totally fascinated by the torrential downpour landing on my maxi-pads. If you're not — and who could blame you? — don't read any further, okay?
See, at first the bleeding was just this thin bright red stream. It looked almost like Kool-Aid, cheerful and watery. When I'd crouch over the toilet, curling over to watch it leak out, it would just flow and flow like urine.
But in the last couple of days I've been producing these awe-inspiring clots. Today I passed one the size of a quarter. The blood has gotten darker, a little more serious-looking, and rather viscous. I'd swear there's mucus in there; when I wipe with toilet paper there are these impressive pink and gooey strings.
I can't wait to see what's next.
The downward spiral
This morning's hCG level seems to have plummeted from 4,583 to an astonishing 317.
Can this be right?
I'd thought it should take approximately as long to come down as it did to go up. I found an interesting note here, though:If this is true, today's number makes a lot more sense than I initially thought.
No major change on the pain front: Still hurts like a motherfucker. I'm experiencing general abdominal cramping, with special bonus throbbing on my lower right side. The nurse assured me this is expected as the pregnancy detaches from the tube. Don't let anyone tell you Tylenol 3 will do the trick, though; hold out for the Percocets. This really hurts. And I assure you I am no piker when it comes to pain tolerance.
I'm also sprinting to the bathroom every half-hour or so, but yielding only these ridiculous little trickles. I unbuckled my belt for that? I'm told that the increased urinary urgency is a result of blood in the peritoneum — I guess that's not supposed to sound as alarming as it does, because the nurse didn't seem concerned.
The bleeding appears to have stopped for the moment. Since this morning I've had only scant spotting, quite a change from yesterday. Overall, I appear to be holding my own, except for the minor matter of abdominal agony, inadequate pain relief, and the complete denial I seem to be luxuriating in.
This too shall pass
All hail my Fallopian tubes. I passed it at last.
The pain was bad throughout the afternoon. I called the doctor's office to ask for some sort of medication. All they could prescribe without an order in writing were those damned Tylenol 3s. (Thanks for the war on drugs, Ronald Reagan. Fucker.) The codeine didn't help much, but I was gobbling them hungrily, for want of any other relief.
By evening, I was spending a lot of time in the kind of pain that made me see stars. The cramping was intermittent but strong. When a cramp came on I was reduced to taking fast, deep breaths to try to work through it. The breathing didn't help but it was the only thing I could think of to do.
I lay in bed most of the time because I felt light-headed whenever I stood. Sometimes I'd walk to the bathroom, sit on the toilet, and then sink to my knees and crawl back to the bed to avoid fainting.
At one point I became convinced that only a hot bath would soothe the cramps. I ran a tub full of hot water and sat in it for about half an hour, until I was well and truly boiled. The hot water did help relieve the pain for a while. When I got out, though, I was light-headed again, so I lay down on the bathroom floor to rest for a while.
Just in case you're planning ahead, a word of advice: Never do this unless your bathroom has been cleaned within, say, the last week.
Another word of advice: If you're easily squicked, read no further. Really.
When I finally managed to stand up, I realized I'd been bleeding all over the bath mat. I also realized that the mass that had been in my right tube wasn't there any more, because I felt it slither down my vagina. I had the presence of mind (and the requisite twisted interest) to cup my hands between my thighs to catch it.
Now, I should make some excuse for my deep fascination with this. All along I've felt like a human science experiment. My body's reaction to the stims, my weird pregnancy symptoms, my apparent inability to miscarry when told to — I've found all of these things mysterious and interesting. Since my narcissism is apparently infinite, maybe it's no surprise that I wanted to inspect the yield this time, too.
And inspect it I did. It was about the size of a walnut, and composed of three distinct parts. Part of it was a giant blood clot. Another part looked like ground meat. The third part looked like whitish tissue.
I wonder which part was which. I couldn't tell. I imagine it had gone through some unpleasant compacting as it got squeezed through the chute. There was nothing there that looked remotely like baby, but then I didn't expect that at such an early stage. It was pretty much what I did expect: a gelatinous blob of rejected tissue.
After inspection, I deposited it unsentimentally into the toilet and gave it the royal flush, with my most intense feeling being relief.
Now, you know, there are women who save the remains of a miscarried child and bury them in the garden. There are women who can't save the remains and agonize because of it. There are women who memorialize their never-to-be babies, who name them, who think of them as angels who simply never had the chance to live on Earth.
I didn't. I don't. This wasn't a baby, a child, or an angel. It was an agglomeration of cells that grew in the wrong place, and that might have killed me had it grown much more. Forgive me if I don't seem, well, maternal.
What I am is tired. I'm feeling exhausted from the pain, relieved that it's over, and strangely peaceful at last.
Note to self: clean floor before dying.
Have you ever honestly thought you were going to die?
The early hours of the morning found me on the bathroom floor again, the floor which needs a good wash now more than ever. I lay there naked on a towel, thinking, I wish I'd made a will.
After I passed the big clump of tissue last night, it seemed that the worst was over. I limped into the den and arranged myself very carefully on the sofa, aching and enervated but feeling rather triumphant. I couldn't stop talking, making poor Paul listen to Blood-soaked Tales of Horror from the Master Bathroom, rendered in glorious verbal Technicolor. I guess I was giddy. I know I was proud of myself for making it through.
When we went to bed, I dutifully took two Tylenol 3s, thinking it would send me into a dreamless sleep of exhaustion. Not two hours later, though, I was back on the bathroom floor, planning my many bequests.
I didn't know whether there was still more tissue that my tube was trying to jettison, or whether it was just trying to shrink back to its normal size, or whether it was spraying a hot jet of blood through my abdominal cavity like a garden sprinkler. Maybe it was all of the above.
Three hot baths and three blood-spattered towels later, I'd finally concluded that it was time to go to the hospital. I'd spent the last several hours arguing with myself. I knew surgery at that point was probably unnecessary, as expelling the mass earlier surely removed the possibility of a tubal rupture. But I was also pretty sure that if I went in, it was fairly likely I'd still be put under and sliced up.
But, see, they'd give me really good pain drugs.
At that point, that's all I wanted: really good pain drugs. Okay, and someone else to be in charge of deciding what to do with me. Someone else in charge of taking care of me, because clearly I was doing a piss-poor job of it, lying naked and whimpering on the filthy bathroom floor.
So I took my last hot bath of the morning. I tried to get dressed quietly, but I woke Paul up in the process. He had to wake up sometime, because I'd decided it was time to call the hospital.
I did, and eventually spoke to the doctor on call. He listened very patiently to my whimpering, and offered the reassurance I needed: "I don't think you're in any imminent danger, and I don't think it's an emergency. You should probably be seen, so you can come in now to the ER, or you can wait until your doctor's office opens and see them then, whichever you prefer. But you're not in any immediate danger."
Paul was already awake and showered and revving the engine out in the garage, poor guy, ready to whisk me away to safety. I decided I'd wait until my doctor's office opened, only an hour from then, so he came back inside and stood by the bed holding my hand while I lay there panting.
I'm pretty sure I've never looked lovelier.
My doctor called in about half an hour, having been notified by the doctor on call. Just imagine it, if you will: "Dude, your patient's having a real, for-true crazy-person four-alarm meltdown." To his credit, my doctor was, as ever, attentive and reassuring. Despite all evidence to the contrary, he succeeded in convincing me that the worst was over, that I just needed to lie still, take enough Tylenol 3 to fell an ox, and rest. I'd spend most of the day feeling like I'd been hit by a truck, he warned, but it would get better.
It did, some. I slept most of the day. When I wasn't sleeping, I was lying in bed feeling like I'd been worked over by Turkish prison guards. But the worst did truly seem to be over.
This morning I left a message for the nurse, just a progress report to let them know how I was doing: slight fever, very painful abdomen, burning when I urinate. I guess those are alarming symptoms, because the nurse called back shortly thereafter and asked that I go in that afternoon. Paul drove, and I kept up a monotonous whine as he hit every bump in the road.
I'm lovable these days.
Now, this particular nurse is very good at her job. She did not say, "My God, which rock did you crawl out from under?" She didn't even say, "You don't look so good." She said, "I'm glad we asked you to come in, because you don't look like you feel very well." May I introduce Sherlock Holmes, R.N.? Wonder what tipped her off. My unwashed hair? My red-rimmed eyes? My hollow, crazed look? The fact that I needed to be flanked on either side as I lurched down the hall to the exam room, unable to straighten up?
I then had a short visit with the doctor, who looked me over briefly, examined my nails and my skin tone, and opined that I'd had some internal hemorrhaging, but that it had stopped. Then he gently prodded my belly to see just how tender it was.
I surprised myself by bursting into tears on the table.
I mean, it hurt, but not that much.
I've simply had enough. I've been hurting for days, feeling entirely abused by the universe. I'd been completely unprepared for the pain, and don't feel that I was properly medicated for it. This was just one more indignity, one more poke, one more vigorous jack-booted kick while I was down, and I lost it for a minute.
That's what it's like. Physically, I'm holding my own; though sore and tired, I'm definitely on the mend. Emotionally, I am 100% tender, well-marbled belly. Enough with the goddamn poking.
Dear doctor, Knock it off. Anxiously, me
At the doctor's office today, I was marveling aloud at the size of the blob of tissue I'd expelled. My doctor said, with just a little too much eagerness, "Yeah, if we'd left it alone you probably would have had a rupture. It sounds like you were pretty close."
Um. Yeah. Thanks. Listen, next time could you say something, you know, reassuring?
Do you think maybe I've given an incorrect impression of how well I'm handling this?