ChezPerky

I realized that I may not have been entirely clear on something and since blogger doesn't support threaded comments, it seems to warrant its own post. In my last post, I referred to the rambunctious three year old in my house. Erin insightfully replied:

…Having a child already does help mitigate some of the pain but in other ways, it makes it even more painful–you'd already started to compare your pregnancy with this child to your pregnancy with your son, thinking about what it would be like to see your son as a big brother, etc…

While it's true that I do spend some time wondering what J would be like as a big brother, I don't compare pregnancies. In four years of trying to conceive, I've had only one pregnancy. My rambunctious three year old is a foster son. I don't think of him that way, because we've had him for two years and he's every bit as much our son as if I'd given birth to him. Still, it changes the dynamic for me in some ways. For example, I never got to experience my first pregnancy in the way normal people do… without other children in the house. When I was dealing with absolutely unbearable exhaustion of pregnancy for the first time, I still had a tornado of a child to take care of. And when I miscarried, even through my grief, I still had a cuddly three year old begging for attention. It makes it harder in some ways, that's true, but easier in so many others.

And interestingly, I think the miscarriage has given me a lot more patience with J. I'm not nearly as snippy. While I don't always have the emotional energy to handle him these days, I don't snap, I just find backup. He's a wonderful kid, but not without his issues, having been bounced around a lot his first year, and yet, I have more patience with him than ever. And somehow, he's instinctively known to listen more to me these past couple weeks.

I think I've done fairly well on the emotional spectrum, and I think a lot of that is because of J. I had two days (not consecutive) of complete breakdowns, neither of which were while J was home and awake. He's done a lot for me in terms of my ability to cope. And I love him just as much now as I did before. I love that I have him to snuggle with and grow with and learn with. I love that I have that little man in my life. I couldn't ask for a better companion, miscarriage or no miscarriage. Mostly, I'm sad that I will have to wait a little longer to see J as a big brother.

I'm not grieving this particular child. Morbid me took a good long look at the fetus and yes, it had arms and legs and eyes and ears, but it wasn't a person yet. What I'm grieving really is the totality of the situation. Four years of trying to conceive. One pregnancy. Lots of hopes and dreams. And those dreams aren't gone…. but they're deferred, somewhat unexpectedly. A friend of mine (a friend who has five kids, mostly grown) gave me a necklace and earrings after the miscarriage… the card said, "Something with which to remember dreams deferred. With gratitude for your friendship. Love, E." Without realizing it, E hit the nail on the head… it's the dreams deferred that was so hard to take, not this specific loss of a person.

And I'm okay. I have the best husband I could ask for. I have the most amazing three year old monster I could ask for. I have options left, which is more than a lot of people I know have. I have good doctors and even if I never had another child, I know that I have a really good life. It's just that I really want those other children. Those dreams deferred. I want to know that the dreams are merely deferred and not cancelled.

There's no possibility that this experience can be looked at as a good thing. It's a horrific, awful thing, and no one is arguing with me on that. But I must still acknowledge that there is positive to be seen in all this. It's good for a marriage to go through the hard times. It's easy to go through the simchas (joys) together, but the strength built in a marriage through the difficult times is hard to replicate. My husband, my greatest joy, has been my constant source of strength since I met him 8 years ago, and these past weeks have been no exception. There is positive that has come out of this ridiculously unfair experience, and I know that. So there you go. My little teeney clarification turned into a big mound of babble. Ah well. It's my blog, I can babble if I want to!

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Earlier today, I read a post reflecting on where things were a year ago in the realm of fertility fun. Oddly, I'd just been thinking of writing a very similar post, because it was just about exactly a year ago that I walked into Shady Hell Fertility Shmertility Clinic and started working with the fabulous Dr. T. And here I am, a year later, finally a pregnancy, sadly a miscarriage, a year older, but not a lot wiser. So where was I a year ago? Here's the response I wrote, which I may flesh out more later, but I wanted to record it here so I don't forget about it:

Where was I a year ago? Gosh. A year ago, we'd been trying to conceive for three years and we'd had five wholely unsuccessful Clomid cycles. My OB/GYN wanted to do one more round of Clomid before referring me to the fertility clinic. I pissed her off by taking matters into my own hands and just going straight to the fertility clinic.

Almost exactly year ago I was getting 14 vials of blood drawn before I could start any fertility treatment. I was having an entirely uneventful HSG. I was still then horrified by having transvaginal ultrasounds (I've probably had another 60 or so since then, so I'm far less horrified).

A year ago I wasn't any more optimistic than I am today. I went into each cycle already planning the next. A year ago, my doctor was telling me I'd never need IVF and that a few rounds of IUI and I'd be pregnant. A year ago I had no idea what to think.

A year ago, I had never contemplated having a miscarriage. In fact, I had just figured I'd never get pregnant, so a miscarriage was inconceivable (no pun intended).

A year ago I had a blog no one knew about (now defunct), but knew very few infertiles in the blogosphere. I never figured I'd be one of "them"… I just never figured I'd make it very far at all.

I realize now, after three failed IUIs and a theoretically successful one which resulted in a miscarriage one day into my second trimester, that I actually have far more optimism than I did at the beginning of this process. When we first started trying to conceive (almost exactly four years ago), it never occurred to me that I would ever get pregnant. Now I can't wait for the next time.

All in all, I think I'm in a better place today than I was a year ago. And I'm very grateful for that.

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Mostly I've been okay recently. I had a followup appointment with my OB on Tuesday (the 17th), and I'm healing perfectly… physically anyway. I was saddened to learn that the hospital was unable to do genetics on the "products of conception". It wasn't anyone's fault, really. The ER handled things properly according to their protocol, but their protocol was not proper for genetic testing (I guess the normal solution that such things are preserved in precludes genetic testing… I'm not entirely clear on the details). I honestly think that the inability to do genetics is the biggest slap in the face of all of this. I feel like I'll move forward somewhat blind, not knowing if this is something I'm genetically destined to repeat over and over. But the odds are that it was a fluke and not something we're predisposed to, so I'll just go with that. Still, I have to say that G-d and I aren't really on speaking terms right now. I know that's probably a fleeting feeling, and life will return to normal eventually, but that's where I am now.

Right now I have a rambunctious, excited three year old riding circles in the living room on his tricyle, completely convinced that he is the world's most acclaimed racecar driver, so what more could I ask for?

On Wednesday, I have a followup appointment with the fertility clinic. My doctor is on maternity leave, irony of ironies, so I'm seeing a different doctor. He's the head of the practice and I've liked him just fine in the monitoring appointments he's been at. In fact, he did my second and third IUIs. I know that in a lot of ways he's the best of the best, and it's his protocol that has made this clinic so successful. Still, I'm sorry not to have Dr. T. who is just an incredibly special person as well as an outstanding physician. I'm mostly afriad of feeling like I have to start from square one if I'm seeing a different doctor. But I just can't be the only person having to have a doctor substitute, so they must be used to this. I know there are some things that I am back to square one on… it's been about a year since a lot of the testing that they run annually has been done. I know my OB re-ran a bunch of the infectious disease testing, but it may be less complicated to let Shady Hell just re-run everything rather than trying to piece together what still needs to be done. I don't know that they'll make me do another HSG (I hope not… I didn't find it uncomfortable like some women do, but it's just more time off of work that I can't afford). I know they'd make me take another course of doxycyclene, but I had to take a round of it after the D&C so that's probably a moot point.

I hope Dr. S. has some reasonable answers and that I don't have to wait months and months to get back on track. I don't want to do IUI anymore. Too many side effects for results far too low, but I'm somewhat worried that Dr. S. will say, "well, it worked once, so we know it works, let's just try again." I doubt he'll actually say that though, since I'm pretty sure they don't make much money off of IUIs, and IVF is their real cash-cow. A physician friend of mine, who had twins with IVF last year, told me that her medical opinion (despite not being an RE herself) was that my only logical next step is IVF with PGD, but I find it hard to believe that one late miscarriage, with no conclusive answers as to WHY it happened equals jumping to PGD, though she's right that it would cut out the risk of having to go through this again blind. Still, something about that scares me. I mean, if we do straight IVF and it doesn't work, we've still got an option… IVF with PGD. But if we jump straight to PGD, that's basically our last option (our rabbi doesn't allow donor eggs or sperm, so really, IVF with PGD is the last choice). There's something psychologically painful about jumping straight to my very last resort (especially since it's unlikely that my insurance will cover PGD at this point without a few more ridiculously late miscarriages… ugh!).

Anyway, I'm babbling, but that's where I am. I'm frustrated to be without a plan. I'm a planner. I always know what my plan B is. Throughout my pregnancy, I was making plan B, plan C, and plan D. I never entirely expected to make it all the way to April with a baby intact, and I was only JUST getting used to the idea that the pregnancy was probably here to stay for a while. So here I am, thrown for a loop, with no plan for the foreseeable future, and THAT is the hardest part of all.

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Mostly I've been okay recently. I had a followup appointment with my OB on Tuesday (the 17th), and I'm healing perfectly… physically anyway. I was saddened to learn that the hospital was unable to do genetics on the "products of conception". It wasn't anyone's fault, really. The ER handled things properly according to their protocol, but their protocol was not proper for genetic testing (I guess the normal solution that such things are preserved in precludes genetic testing… I'm not entirely clear on the details). I honestly think that the inability to do genetics is the biggest slap in the face of all of this. I feel like I'll move forward somewhat blind, not knowing if this is something I'm genetically destined to repeat over and over. But the odds are that it was a fluke and not something we're predisposed to, so I'll just go with that. Still, I have to say that G-d and I aren't really on speaking terms right now. I know that's probably a fleeting feeling, and life will return to normal eventually, but that's where I am now.

Right now I have a rambunctious, excited three year old riding circles in the living room on his tricyle, completely convinced that he is the world's most acclaimed racecar driver, so what more could I ask for?

On Wednesday, I have a followup appointment with the fertility clinic. My doctor is on maternity leave, irony of ironies, so I'm seeing a different doctor. He's the head of the practice and I've liked him just fine in the monitoring appointments he's been at. In fact, he did my second and third IUIs. I know that in a lot of ways he's the best of the best, and it's his protocol that has made this clinic so successful. Still, I'm sorry not to have Dr. T. who is just an incredibly special person as well as an outstanding physician. I'm mostly afriad of feeling like I have to start from square one if I'm seeing a different doctor. But I just can't be the only person having to have a doctor substitute, so they must be used to this. I know there are some things that I am back to square one on… it's been about a year since a lot of the testing that they run annually has been done. I know my OB re-ran a bunch of the infectious disease testing, but it may be less complicated to let Shady Hell just re-run everything rather than trying to piece together what still needs to be done. I don't know that they'll make me do another HSG (I hope not… I didn't find it uncomfortable like some women do, but it's just more time off of work that I can't afford). I know they'd make me take another course of doxycyclene, but I had to take a round of it after the D&C so that's probably a moot point.

I hope Dr. S. has some reasonable answers and that I don't have to wait months and months to get back on track. I don't want to do IUI anymore. Too many side effects for results far too low, but I'm somewhat worried that Dr. S. will say, "well, it worked once, so we know it works, let's just try again." I doubt he'll actually say that though, since I'm pretty sure they don't make much money off of IUIs, and IVF is their real cash-cow. A physician friend of mine, who had twins with IVF last year, told me that her medical opinion (despite not being an RE herself) was that my only logical next step is IVF with PGD, but I find it hard to believe that one late miscarriage, with no conclusive answers as to WHY it happened equals jumping to PGD, though she's right that it would cut out the risk of having to go through this again blind. Still, something about that scares me. I mean, if we do straight IVF and it doesn't work, we've still got an option… IVF with PGD. But if we jump straight to PGD, that's basically our last option (our rabbi doesn't allow donor eggs or sperm, so really, IVF with PGD is the last choice). There's something psychologically painful about jumping straight to my very last resort (especially since it's unlikely that my insurance will cover PGD at this point without a few more ridiculously late miscarriages… ugh!).

Anyway, I'm babbling, but that's where I am. I'm frustrated to be without a plan. I'm a planner. I always know what my plan B is. Throughout my pregnancy, I was making plan B, plan C, and plan D. I never entirely expected to make it all the way to April with a baby intact, and I was only JUST getting used to the idea that the pregnancy was probably here to stay for a while. So here I am, thrown for a loop, with no plan for the foreseeable future, and THAT is the hardest part of all.

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I hadn't been able to keep any food down at all last week, and by Friday I couldn't keep fluids down either. Couple that with some pretty serious cramping (getting progressively worse) and I landed myself back in the emergency room Friday night. Many of you probably know that I'm an Orthodox Jew, so this was somewhat complicated, as it was the Sabbath for me starting at Sundown, and there are all manner of Sabbath restrictions, including no driving, so I had to make arrangements for someone to drive me home once all was said and done and it was just more complicated than I would have liked. Also, I sat in the waiting room for 3 1/2 hours before they remembered I was there (they admitted to having forgotten about me, so I'm not just being bitter when I say that). Anyway, the cramping doesn't appear to have any important cause… they did an ultrasound and everything looked okay. I wasn't so much worried about the cramping as I was the dehydration, but they gave me IV fluids and antinausea medication on top of the lovely pain medicine they'd already given me. I was pretty happy then.

Now I feel like I've been doing situps all weekend, which is ridiculous, but unpleasant. The pain hasn't subsided in the least, but I'm happy that there's no good cause for it. I have an appointment with my OB on Tuesday, but I expect I'll be fine by then (but I still have to see him regardless to follow up re: the D&C so that he can make this month's car payment).

Have I mentioned lately how much I love my OB? I just can't get over how wonderful he was to me on Monday night. So I wrote him a letter. I have no doubt that he gets a lot of letters and baby pictures when everything goes right. But I doubt he gets a lot of positive acknowledgement for his role when things don't go right. So here's what I wrote:

Dear Dr. B;

I am writing to thank you for the exemplary care you provided me on Monday, October 9, 2006 when I had a miscarriage and subsequent D&C at HC Hospital 12+ weeks into my pregnancy. I would like to take a few minutes to explain to you why this means so much to me.

After four years of trying to conceive, five rounds of Clomid, and four IUI (with injectible gonadatropins) attempts, I was caught by surprise to find out I was pregnant. When my doctor at Shady Hell Fertility Shmertility Center, Dr. L. T., told me that what had originally appeared to be a miscarriage looked like a viable pregnancy, I didn'’t experience the same joy that I imagine most newly-pregnant women experience. Rather, I was afraid. I was afraid to leave the safety net of the fertility clinic and the rapport I had established with the doctors and staff there. I was afraid I wouldn'’t find an obstetrician I could trust. Most importantly, I was afraid I would miscarry before I even made it to my first pre-natal appointment. I had never given much thought to finding an obstetrician I could trust, under the assumption that it would never become relevant.

On the recommendation of Dr. T., and the recommendations of other friends, I made an appointment in your office for September 20th, 2006, when I was 9 ½ weeks pregnant. I knew at my first appointment with you that I had made the right choice. You took my concerns seriously, but were not overly anxious (your words were, "“It’s really hard to mess this up; women have been doing this for a long time”"). I had been experiencing bleeding throughout my pregnancy, and you carefully reviewed my medical history, the records provided from Dr. T.'’s office, and did a physical exam to ensure that there was no cause for alarm. I appreciated your calm, but thorough, nature immediately.

At my next appointment on October 4th, everything seemed fine and we heard a heartbeat and all was well. I asked if I needed to have any concern, as the bleeding I'’d been experiencing had increased dramatically the previous weekend. Though we had not planned to do an ultrasound at that appointment, you immediately offered to have an ultrasound done to make sure nothing was wrong, even though it was likely nothing to be concerned about. Sure enough, the baby was fine, measuring exactly 11 ½ weeks, with fingers, toes, and a heartbeat. You told me I had a subchorionic bleed, something I should not be concerned about, which does not cause miscarriages, and would resolve itself on its own over time. It was a relief to know that it wasn’t all in my head. In retrospect, I am very grateful that the ultrasound was performed that day, because it gave me a glimpse of a healthy baby, something I never thought I would see on an ultrasound of my uterus.

Despite two promising appointments, and a total of four promising ultrasounds, on Monday, October 9th, I began to have severe contraction-like pain, with significant bleeding. I paged you, but within a few minutes of paging you, the contractions had become so frequent and severe that my husband put me in the car and drove me to the hospital. (Upon my return home, I discovered that you had called back a few minutes later, and followed up with another call to make sure everything was okay) An hour later, I miscarried in the emergency room and the ER physician, Dr. G., called you. I expected that I would either be told to go home or a doctor I didn'’t know would perform a D&C if necessary. Instead, I received a phone call from you directly, something which I genuinely appreciate, though it was neither expected nor required. In our short conversation, you expressed sincere regrets and assured me that there was nothing I could have done differently to change the outcome.
You made immediate arrangements to come to the hospital and perform a D&C as I was still in tremendous pain and experiencing heavy bleeding. Your swift response was extremely comforting.

I learned later that you had spent the entire day at the hospital, and I know that my call pulled you away from your wife and your family after what must have been an exhausting day. Yes, it’s “all part of the job”, but I know that it takes a special kind of dedication to enter a profession with those kinds of demands on your time. I experienced tremendous relief when you arrived in the OR area where I was filling out forms and waiting for the D&C. You quickly reviewed the pregnancy history with my husband and me, and again expressed your sincere regrets for the loss we had experienced, and suggested some options for finding answers to the questions we have regarding why I experienced such a late miscarriage, saying that you would be as aggressive as we wanted you to be in finding out the answers. I know that a first miscarriage in a first pregnancy is not normally cause to aggressively seek such answers, but given my history of infertility, I am extremely grateful for whatever answers (if any) you are able to uncover. Once again your calm, but thorough, nature was comforting for both my husband and me.

Your gentle care, your thorough manner, and your swift response made a real difference in how I will look back on this otherwise rather unpleasant experience. I never felt anything but complete confidence in the care you were providing, or the choices we were making. And I have never been so certain that I chose exactly the right provider for my obstetrical care, no matter how short that care period turned out to be. I cannot thank you enough and I hope to someday soon enter your office with news that I am pregnant again.

Sincerely,

KEC

It wasn't an easy letter to write, but I'm glad I did. It was rather cathartic, but more importantly, I'm glad I had an opportunity to communicate my appreciation to my doctor. He was extraordinary.

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