ChezPerky

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.

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.

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.

I called to make an appointment with my fertility specialist. I trust my OB and I know he'll be very aggressive in trying to determine the cause of the miscarriage, but I also know RE's and OB's sometimes look at different sides of a problem, so I want to make sure they're communicating with each other. I don't want my OB running a battery of tests and then three months later having the RE say, "why wasn't this test run?" I don't want two rounds of testing. I want it over with. I want to know what the next step is, even if the next step is "do nothing." I love my fertility specialist. She always treats me like I'm the only person on her mind; she remembers random things about my life; she listens and considers her answers to my questions carefully, and she asks appropriate questions.

She is also, apparently, on leave for at least three months. I hope everything is okay. I don't know why she's on leave, but she didn't mention it when I saw her a few weeks ago, so I'm guessing it was rather sudden. I'm worried about her, but my selfish self is, well, being selfish. I want her, not some substitute!

I have an appointment with another doctor in the practice, a doctor I have a lot of respect for and whose opinion I trust. In fact, there's only one doctor at that office that I don't care for, so I really had my pick of a lot of really good doctors. Dr. S. has been in the business a long time, he's the best of the best in a lot of ways. He's funny and smart and he listens to me when I see him for monitoring appointments and I know he'll be a fine subsitute. I always knew if I hadn't been originally scheduled with Dr. T, that I would have been very happy with Dr. S. But he's not her. And he doesn't know me. And I'm a lot more than what's in my chart. So my selfish self is pleased to have such a fun, amazing substitute who knows the field as well as anyone else, but sad to not have Dr. T to turn to right now.

Mostly, I just want to know where to go from here, in as prudent a fashion as necessary, and I want input from both sides of the fence (OB/RE sides), so seeing Dr. S. is fine. I just hope I don't end up feeling like I'm starting from scratch.

This sucks a lot more today than it did yesterday.

There's a whole lot of TMI to follow, so seriously… don't keep reading if you're squeamish, but I really needed to write this. For me.

Every time I close my eyes all I can see is all that blood. I remember that no one seemed concerned except me (and Seth). We walked into the ER and once we got to the registration desk, I fell to the floor in pain and couldn't get up for several minutes. I never should have gotten up into the wheelchair after the contraction (as I now know it was) passed. If I hadn't gotten up, they might have seen me sooner. It wouldn't have made a damn bit of difference in the outcome, but it might have meant fewer minutes of sheer terror. In the waiting room, I sat across from the triage desk literally bleeding on the floor and no one seemed to notice. Every contraction left me sobbing for relief and no one seemed to notice. No one, of course, except for Seth and the six year old who kept asking his mother why that lady was crying.

Finally Seth convinced them to take me into triage ahead of the queue and I was wheeled into a nurses station, doubled over and sobbing in pain, watching blood drip on the floor. "Are you in a lot of pain?" the nurse asked. I couldn't even answer her. Now I know what it's like to not be able to talk through a contraction. "Are you pregnant?" I wanted to say, Are you fucking kidding me???, but I could only wildly gesture. "Is she deaf?" the nurse asked my husband. "No, she's just in a lot of pain, and yes, she's pregnant." I kept pointing to the floor desperate to get someone, anyone to notice the blood underneat my wheelchair. No one seemed to notice. No one, of course, except for Seth. She took my blood pressure (163/85… not so great) and my temperature (100.5, not great, but not bad) and my pulse (113, not great, but not as bad as I would have thought). How on earth do I even remember those vitals? "My wife has had 12 kidney stones, so when she says she's in pain, she means it," Seth said sensibly. "Oh? Does this feel like a kidney stone?" No you idiot, I'm pregnant and bleeding on the floor!

The nurse wheeled me to a room, but the room wasn't ready, so I waited in the wheelchair in the hall, sobbing and doubling over with each contraction, bleeding ridiculously. No one seemed to notice. Finally, someone asked if we were being assigned a room. "I think so," said Seth. "We'll get you in as soon as we can, and someone's going to bring you something for the pain, okay?" Another contraction, another sobbing fit, a small prayer. I'm not sure why it took me that long, but that's when I knew there was no way that I was going to leave the hospital pregnant. I mean, I walked into the hospital knowing there was a good chance that I was miscarrying, but it was with that contraction that I knew I wasn't going to have a baby in April, or anytime before then.

Once I was in a room, they worked swiftly. The nurse got an IV line in, and drew blood. She left momentarily and I had a ridiculous contraction and finally, I felt something far too large to be a blood clot slide out of me. And that was it. "What if that's the baby!?" I asked Seth. It's the first time I'd ever referred to it as a baby. "Don't think about that. I know it's on your mind, but don't think about that," he said. The doctor came in to see what was going on and said she was going to do a quick internal exam and then send me to ultrasound to see what was going on while she called my OB. But she saw all the blood and she said she there was the gestational sac with the fetus intact. My cervix was still open. That was it. I was really okay. I was still in pain, but I had expected her to say the "m" word and it wasn't a shock. It wasn't the cathartic moment I would have expected. I didn't melt into pieces. I just said, "yup." She got me more pain medicine. 1mg of dilautid didn't work. 2 mg of morphine didn't work. Another 4 mg of morphine didn't work. But she said I could keep asking and they'd keep giving me more.

She called my OB to see if he still wanted to do the ultrasound, and just as a transport tech came to take me to ultrasound, my OB called the room. He said I could do the ultrasound, which would show whether there was still placental tissue requiring a D&C. "But this far along, it's extremely unlikely that you have gotten all of it out, and you probably need a D&C." Would I prefer, he asked, if he just came straight in to do the D&C? It would, after all, save a couple hours of wondering and get me home much sooner. Yes, that's really all I wanted. They cancelled the ultrasound order. A new nurse (shift change) came in to get some information. Sheri arrived with a new change of clothes for me since I knew there was no way I'd be going home in the clothes I came in. Seth asked for more pain medicine for me, but since I was going to be going to the OR soon enough, they didn't give me more. An hour later I was taken to the OR cursing the lack of pain medicine.

The OR staff was terrific. The anesthesiologist became my new best friend. My doctor arrived in jeans and a button down shirt, and talked to us for a little while. He told me he would be as aggressie as I wanted him to be in finding out why I miscarried. I told him I wanted more information than I needed and he said no problem. He was very sorry, and acknowledged that there was nothing I could have done differently. Everything was fine a week ago. Perfect heartbeat. Perfect fingers and toes. Perfect size. Perfect everything and no reason to worry. Things moved pretty swiftly and I was sent into an OR and drifted off into blissful sleep as soon as my doctor arrived in scrubs and a mask. Half an hour later, I woke up in far less pain and a few ounces lighter and I was sent into post-op with a bag full of pitocin dripping into my IV. It was very quiet in post op.. the only other patient was discharged just as I was arriving. My doctor told me my uterus was very large (not a surprise, given how far into the pregnancy I was), but that everything was okay and he'd saved a lot of tissue to send to the gentetics lab to do some testing. And I should see him again in a week to follow up and make sure I'm healing appropriately. Once the tests are in, we'll know more and he'll call me.

I know intellectually that even if I hadn't been waiting in the ER waiting room for so long that this would have turned out exactly the same. But there was such a stark difference from that frustrating time trying to get past triage and then once doctors actually became involved and how well I was cared for that I really resent having to sit there pointing stupidly at the floor. The ER doctor and my OB were both exemplary and I can't possibly ask for much more. I'm so grateful that I was in their care, even if the end result is a giant black hole of sucky suckiness.

And that's really all I have the emotional energy to write at this time. Thanks to all of you who left comments. I'd like to respond to them individually, but I can't right now, but I do so appreciate the people in the blogosphere are thinking of me. Somehow it's easier to be honest inside the computer than face to face with anyone. It's sort of ridiculous that that's how it is, but I hate crying in front of people… it's far too personal, and far too ridiculous looking. Anyway, thanks.