15 July 2008

Blood, sweat, and tears

Two weeks ago, when what I thought was my period arrived a few weeks late, I figured either perimenopause or Mexico was the likely culprit. I was about to turn 45, and we had recently celebrated our 20th wedding anniversary with a trip to the Mayan Riviera, with our heat-daunted daughter in tow but who nevertheless posed no obstacle to relaxation and refreshment for all at beaches and pools and walks and swings at the bar down the beach and a memorable couple of nights when we had to blast the air conditioner for an extra long time.

A few weeks later and I woke up many times in the night, sweating, stiff in my lower back,, and wondering where all the blood was for all of this sturm und drang. The next day, I met with a friend with whom I had been planning a film project, and halfway through our meeting the cramps came on, only they were far worse than my usual pains. Still I didn't realize what was happening. The cramps continued, on and off all afternoon and into the night. I took ibuprofen, but it didn't work any of its usual magic and I was in so much pain I couldn't sit at the table to eat dinner that night with my sweetie and our daughter.

The next morning, I was experiencing far more than the usual flow, and then such a volume of blood clot and tissue came from my body that I got the first inkling of what had really happened.

The next day was the Thursday before the 4th of July holiday. I went to my gynecologist's office for a checkup, and they examined me and had me stay for an ultrasound. I have a lengthy history of endometriosis, which has resulted in several ovarian cysts, uterine fibroids, and a couple of surgeries to remove them, and which has remained the only explanation of why I never conceived. The physician's assistant who saw me had me get my blood drawn so they could do a few tests, including one for pregnancy. I got a call later that afternoon from the physician's assistant I had seen earlier. She said my pregnancy test had turned up positive, but they were concerned that I had an ectopic pregnancy, because of a mass near my left ovary. (Ectopic pregnancies develop somewhere other than the uterus, and if they occur in a fallopian tube, they can quickly turn painful and even life-threatening. A friend of mine experienced this when she and her husband were trying for their second child. Now she has one fewer ovary and her older child has a little sister from China.)

On the phone, I burst into tears at all of this news. “Oh, how terrible for you, the worst possible thing,” the P.A. said, trying to empathize. Earlier she had told me she has three children. “After all those years of trying, this is the worst,” she went on, as I wept and thanked her for understanding. “Wait for a call from the doctor; she's on call but she may want you to come to the hospital tonight for surgery,” she instructed.

I called my husband at work and told him what I had just learned.

“I'll be right there,” he said immediately, adding, “I love you.”

While we waited for him to get home, I tried to explain to our daughter why I was so sad and worried. I was sad about not being able to have a baby. I was worried about needing emergency surgery.

My daughter studied me when I was crying, and cried with me. “Will you go into the hospital and get a shot? I'm worried they'll give you a shot and you won't wake up.” She had seen this with her cat Sophie at her life's end, which we hastened to keep her from suffering any more, and with the collapse and euthanization (the epitome of euphemisms) of Eight Belles, all over the news and commentary this spring. We assured her that I would be fine, that people do this kind of surgery all the time, and would be able to help me stay healthy and well. And our daughter cried for the same reason I did: “But I wanted a sister.” (Of course, this is a ongoing refrain that's been even more frequent during bouts of summer-break boredom.)

Half an hour later, my husband was home and we all cried together. All that pain of being unable to conceive ten years earlier, before we'd gone to India to adopt our beautiful daughter, had come right back up to the surface as if no time had passed at all.

We spent the next couple of hours waiting for the doctor to call me, but when we had not heard from her by 4:45, I called the office.

“I'm waiting for a call from Dr. X,” I said.

“Well, she's on call, and she's in the O.R. on a delivery right now. I would suggest you call back Monday morning.”

“Whoa. I just got a call a couple of hours ago from your P.A. saying I might have an ectopic pregnancy and may need surgery as soon as tonight,” I told the receptionist. “And I don't remember the name of the doctor who is supposed to call me. Can you look it up in my chart?”
“I can't do that, and everyone is leaving in ten minutes.”
“Okay, then can you please have the doctor call me?”
“I'll leave her a message.”
It was an unsatisfying exchange, but a few minutes later, the physician's assistant called me back and gave me the name of the doctor on call. She also suggested I call at 6:30 if I hadn't heard from her. When 6:30 came around, I still hadn't received a call, so I left a message with the answering service to page the doctor. She called a few minutes later and said she'd been in the operating room all day, but she'd call as soon as she possibly could.

At about 9 that evening, the doctor finally called me and went over everything she knew. I had some endometrial cysts, one of my chronic complaints and a probable cause of my infertility (although oddly I have never seen myself as “barren,” never identified that word nor idea with myself the way I could have done, in all these years. Her reading of my hormone levels and my ultrasound was a little different from the P.A.'s, however. The doctor said the ultrasound results suggested the possibility of an ectopic pregnancy, but she said given other signs, it could be a “normal, intrauterine pregnancy.” By the time I hung up I knew even less than I thought I had known before. I could have an ectopic pregnancy, I could even have a “normal” pregnancy, or I could have had a miscarriage.

I thought of the “tissue” I had passed -- I would draw out the word when I described it to the medical staff that had come from my body more than a day before. I had a strong and sinking feeling I knew what had happened. A little later I tried it on and it fit, telling people I knew that I had been pregnant but I was pretty sure it had ended six days before my birthday, a day, incidentally, that had long been significant to my family: my mother's birthday, my in-laws' anniversary, and the anniversary of my sister's death 41 years ago.

Instructions from the doctor were to wait another day and a half and measure my hormone levels with a second blood test, which would prove more conclusively what was going on. We had no choice but to spend the next couple of days feeling all the sadness and anxiety about this new set of options in our future or perhaps only our past. We experienced delayed and not delayed reactions to all of these bits of information, and simultaneously plunged right back into the despair we had felt ten years at having been unsuccessful in all of our attempts to get pregnant with our child.

Our child, it turned out, was destined to come to us via another route, however: just over a year after deciding against in-vitro fertilization, which for us would involved massive quantities of driving forty miles round-trip and having to self-administer injections almost daily, its invasiveness was as odious to us as having to inject our beloved kitty with fluids every day to keep her alive for what we thought might have been just a few more days.

Later, long after we had brought home the little miracle girl who had toughed out three days at birth with minimal care and the subsequent climb to thriving that took her a full three months so that she was really just becoming stable when we adopted her at five months of age, after Indian families had been offered the opportunity to adopt her, should anyone want to make such a claim. Not many Indians step forward to bring a premature baby girl into their families, for long-held cultural reasons that thank goodness have no bearing on my own wish to love a child, to share the good parts of life with another little person on the planet. We decided to keep her beautiful orphanage name, despite advice to the contrary, but I saw an opportunity to preserve a tradition in my extended family that could be unbroken if we granted our daughter the same middle name (now and then, our youngster says she's going to make everyone call her by her middle name, but to date she has always backed down from that stance quickly). She chose her name, as is traditional in her culture: read The Namesake by Jhumpa Lahiri for more details on pet names. Hers even has a nonsense, random quality that is typical among Bengalis. She picked it as if from the top of a tree, like it had been made for her. She has had that name ever since. Some day she may even decide to name herself anew.

Much later, as we made the rounds and visited the adoption agency to check in and let them know we were all adjusting well to our lives, falling in love with each other right on schedule, I was surprised to notice mixed reactions from the staff at our hospital's fertility clinic when I brought my little brown toddler up to the sixth floor to show them a different happy ending. Only after we'd left the office did I realize our presence announced their failure to help us louder than anything else could have, especially in our having different color skin from one another, so I could perceive how they weren't as excited to see us as I'd naively imagined they might have been.

But we moved forward into our lives, answering each emerging question as best as we could, with the welcome help of Google and Wikipedia. We started speaking to her about the natural world as plainly as we could, but without dumbing down our vocabulary. When she was tiny I imagined her wowing people with big words from her charming little self and endearing voice and this indeed came to pass as I had already seen it unfold. Now we have a smart, challenging, loving and greatly beloved little girl in our midst.

Right around the same time as our pregnancy event, whatever it was turning out to be, my sweetie and I both practically simultaneously confessed to each other that we had both been hearing sounds and voices in our house. Whistling, talking, other sounds. Ghosts. Our child has always asked about ghosts, and I know the man who lived here before us lost his wife to cancer, so it wouldn't surprise me if we had a ghost or two hanging around here.

I had also recently started noticing an odd phenomenon of being able to foresee things, like seeing a flash of light around things that were going to come true. They were odd little details, things like knowing answers to questions before I called someone on the phone to ask something specific. Most were random (I knew before I called my bff that she wanted me to bring salad to her party, even though earlier she had said dessert). One such little omission, a flash of light I was not seeing, was the film I had talked about making with my friend. I felt I had formed an image of how we would proceed, but it was patchy, all constructed out of memories. I didn't see the flash of light around me at the events we planned to film. I didn't feel the flash of light on me setting up the camera for an interview, nor did I see it on my role in recording or even witnessing the big performance Saturday night, the one I'd not only cheered on for several years running but even danced in myself one year.

The day of my miscarriage was the day I read in my mailbox the message from the camp director stating she was “thrilled” that two films were being made about this wonderful heritage fest, announcing ours and another filmmaker's project.
Two days later, we got the news that my hormone levels were dropping enough that they could rule out the ectopic pregnancy and conclude that I had indeed miscarried. Further tests confirmed this more conclusively still; the cysts were ruled less urgent and will be watched for a few months after my cycle starts back up. Hard to believe that less than a month ago, I'd been guessing I was entering perimenopause for serious-real.

This morning, someone thanked me for sharing my story of what had happened with them. It didn't matter that I had joined this group only a month or so earlier; I had been feeling like I had found this group in just the nick of time for throwing me the floaty rings I needed at the moment. “I have been telling people,” I confessed. “I mean, I didn't tell the mail carrier,” I added wryly and got a laugh from the Southern ladies in the group. But a little part of me felt I could have told our mail carrier, who we see around town sometimes with her kids or in the pool and of whom I think as another wacky-haired mom.

One thing I've noticed in the years since we decided to adopt a little girl from India is a willingness to be unusual. It's completely obvious that we are not your ordinary genetic blend of a family when you first see us. We've met parents who don't feel like telling their kids about it, but anything else to us would not have made sense. Sometimes our daughter does as we feared and rails against not knowing who her birthparents are, and sometimes she aches deeply with questions about who they are and whether they would make her feel better when she's sad or mad.

So somehow I chose myself as someone who would have a lot to explain about my child's origins, and not much basis for my explanations. We took opportunities we had to go to the orphanage, to spend time there, to visit our new child. We wanted a chance for her to get used to us before we whisked her away into an entirely different place and climate, a new set of smells, sounds, and sensations.

Now, experiencing this shock of fertility and infertility anew and again, respectively, I find myself willing to live my life in public a little more than I ever did before. I try to find appropriate boundaries and not burden the mail carrier, for example, with T.M.I. (too much information) and a permanent association between me and a tragic event. (I know this first-hand because I once delivered newspapers for a while as a kid and still, thirty-some years later, remember some of the odd details I knew about the people who lived in the neighborhood when I pass those houses.)
On the phone with my mom, I tell her I understand now how books with dramatic titles have come out of experiences like mine. “'Miscarriage: The Silent Tragedy,' that sort of thing,” I say. Because I see how it got pooh-poohed by male doctors who hadn't experienced it.

Later, another veteran, of one miscarriage followed by three children, says the pain of the miscarriage was far greater than that of giving birth. I was amazed to hear it, but also glad for a little validation of the terrible pain of the cramps I had been experiencing, for days and days after I had thought it would have stopped. I figured they would last five days, maybe a week. Looking back, I probably based this guess on my estimate of a typical length of a period, the only standard I'd had to date. I turned out to be wrong, by about a week.

Every now and then, often in the evenings but sometimes midday, I would suddenly start cramping like made, enduring pain that brought back childhood memories of huffing women in Lamaze classes. My mother was a midwife during most of my teens and had been a patient of a doctor who became famous as a champion of “natural childbirth,” so I learned early on about differences between labor and “Braxton-Hicks contractions” (“Why are they named after a man?” I asked at about age twelve, to the laughter of a room full of earnest, freshly liberated Boulder women during one of the classes I happened to attend). I always presumed I'd experience that difference one day for myself.

And now that this process has been short-circuited, I feel I have to say it out loud a few times, the way I told the world I was adopting a little girl from another place and culture despite the obstacles. I find myself willing to break the taboo, not quite willing to refer to my tragedy either obliquely, as, say, a more generic “health scare,” but as a tragedy and a shock, a loop I have been thrown for recently. For that is how it feels to me now, as if I'm looping back over territory I thought I'd left behind, roads that had been forever marked “no outlet.” Not so fast.

Now we find ourselves asking, “What if?” As in not so much “What if we had gotten pregnant,” because we didn't. But as in “What if we did again?” “What if we could get pregnant?” It feels like I got a late entry to the group of women who have been pregnant, even if I stopped being pregnant before I'd even realized I was pregnant.
I don't know what it means that it's not impossible, yet at 45 it does feel too late, and this is sad, especially when our daughter says sadly that she wishes she had a sister. “Or a brother,” we remind her, and this makes us sad all over again. We both worry that my physical or mental health could be at risk if I did get pregnant, so that helps us feel better, like this was the right thing.

What I notice as I go around telling people here and there – my neighbors I tell right away, thinking we might need extra help with childcare if I do have to have surgery for an ectopic pregnancy – is that I feel perfectly okay about sharing it with people I never would have guessed I would have, even if not the mail carrier. There is a community there, and even among the people I speak with who have never experienced it themselves (my closest neighbors, for instance), everyone knows someone who has been through it. I find great solace in that alone for me. It does help knowing this is not unusual or unthinkable.

Most of all, as I have spoken my truth to those nearest and dearest, I have felt loved and buoyed by all these hands around me, by all these people who encircle me. There's so much good in all this. I see that cliché about finding out who your friends are from a new, sweeter angle. Despite the suddenness of the pregnancy and its end for us, any pregnancy, including this one, is such a miracle. And yet we didn't feel we had lost a baby; that gob of “tissue” I carefully wrapped in toilet paper and put in the trash (and even surreptitiously peeked at once the next day) wasn't viable, wasn't a baby or even a fetus. It was stuff, not people.

Today I feel a great relief, even as I grieve the loss of possibility that the two of us could make a child come into the world ourselves, too. That little critical inner voice asks whether it's cold of me to be this pleased about just having my body belong to me and not be taken over by this process (I couldn't help thinking about parasites and succubi once or twice -- it's weird how fast the hormones do swoop in and get to work on your head and body).

But I just can't say how grateful I am for the love. Love is all. Those Beatles knew what they were talking about.

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