Reflections on a sad day

I'm sad today.  Everything is fine in Megs Land, but things are not fine in IF Bloggy Land.  My friend Adi (I used to call her Anne, but her name is actually Adi) from the Second Bedroom, who just got her very first positive pregnancy test the day before Thanksgiving, went in for her 6 week ultrasound today and got bad news.  Not only did she get bad news, but it was given to her tactlessly and callously by a jerk doctor (not her regular doctor).  I am a firm believer that ultrasounds before 7 weeks are generally bullshit and are designed to upset us.  So a small part of me still holds out hope that something miraculous will happen for her.  I think I've mentioned before that I am in a private Facebook group for other pregnant infertiles, and three of the women in that group had terrible scans at 6 weeks (empty sacs) that turned into fetal poles with normal heartbeats at 7 weeks.  So look, it can happen.  But I realize that those women are the exception, not the rule.  And indeed, if you looked back at my miscarriage last June, my story certainly wouldn't fill anyone with hope.

Adi's situation has me reflecting back on my own miscarriage.  I told her earlier today that while it was too early to make such a decision, if the time came and she wanted to know about my experience with a D&C, I would tell her about it.  As I thought about it, I figured maybe it would be best to just write it out here.  Maybe it will be useful to someone else down the road.  Adi, you're not alone, even though I know right now is probably the loneliest you've felt in a long time, if not ever.  This story won't be gory, but there will be some mention of bodily fluids, so if that grosses you out, feel free to skip this post - I'm hoping to write about happier things later this week.

Quick recap of my miscarriage.  I got pregnant with IUI #3 and had normal betas for the first 3, but the fourth beta rose much more slowly and my RE's office freaked out, worrying that it might be ectopic, so they made me come in for an early scan.  At 5w5d, I had one gestational sac, measuring behind.  At 6w5d, I had a gestational sac measuring on time, with a yolk sac.  At 7w3d, I finally had a fetal pole, but it was measuring 6 weeks (over a week behind) and there was no cardiac activity.  My RE diagnosed a missed miscarriage, but asked me to go for high resolution scan as a second opinion.  At 7w4d, my RE's diagnosis was confirmed.

My RE called me as soon as she got the confirmation to discuss next steps.  I could (1) wait for a natural miscarriage - this could take up to 4 weeks; (2) take medication to induce the miscarriage; or (3) have a D&C.  We discussed the pros and cons, but because I am me, I had already done a lot of research.  I knew I wasn't interested in waiting up to 4 weeks for a natural - I was terrified of being in the middle of a work meeting, or out to dinner with friends and suddenly being incapacitated by cramps and bleeding.  I was concerned about taking the medication because I had read a study that indicated that up to 30% of the women who take the meds wind up having to have a D&C anyway.  I had also read some anecdotal stuff that made me worry about the amount of pain I could expect from the meds.  My fear with the D&C was the risk of scarring.  I talked it over with the RE and she confirmed there is a small risk of scarring with a D&C.  Ultimately, I decided I wanted to do the D&C - my RE could test the products of conception (POC) and tell us what had happened (some REs will test the POC for you if you collect it at home with a natural miscarriage or from taking the meds - my RE doesn't do that), I would be in control of something, and the physical pain would hopefully be less.

At 7w6d, I went in to my RE's office for my D&C in the morning.  It was mid-June, but it was cold and rainy, which seemed about right given my mood.  Of course Jeeves came with me.  I checked in and was called back right away.  I had gotten a little snotty with the desk clerk who told me that I would have to provide a urine sample - turned out he was wrong.  I was pissed about it because they don't want you to drink or eat anything after midnight and I had already peed that morning.

I got into my little gown, booties, and put my shower cap on, and then sat in a chair, waiting to be brought back.  Dr. R, one of my REs, was there, greeted me and asked me some questions.  Then I met the anesthesiologist, who was so very nice.  "I see you brought your veins!" he said, gesturing to my hand.  We talked about my previous experience with general anesthesia (from wisdom teeth extraction), and then I had to sit and wait a few minutes.  As I was sitting, they wheeled the last patient out.  She had clearly just had a D&C.  I say "clearly" because she was crying and wailing to the nurse "It's just so sad!  So sad!"  She was also in a lot of pain!  The anesthesiologist had to give her a shot of something special, and she would periodically moan, back behind her curtained area.  That seriously freaked me out.  "Everyone on the internet said that a D&C wasn't that painful!" I internally spazzed.

They brought me back to the operating room, and the table was quite comfy.  The very first thing Dr. R did was check one last time on ultrasound to make sure nothing had changed.  I had read some stories on the internet about women who got to this point and there was miraculously a heartbeat when the doc did the last ultrasound check.  That didn't happen for me.  Nothing had changed at all.  It was sad, but it reinforced for me that I was doing the right thing.

The anesthesiologist put the IV line into the back of my hand.  That was seriously the most physically painful part of the entire process.  Truth.  As he did that, we talked about my job, the mayor of New York, Germany (where he was from), and the environment.  He was really good at distracting me, and I'm still thankful for that.  At one point he asked me if I had any children, or if this would have been my first.  I explained that it would have been my first.  He asked if we would try again. I said yes.  He said, "Good.  Don't give up.  It's so worth it in the end."  I appreciated his kindness.

Dr. R and the nurse came back in, and after they confirmed for the gajillionth time that I wanted the POC genetically tested, the anesthesiologist put something in my IV line and I remember thinking, "Hmmm, those lights look funny."  

What felt like a few minutes later (but was in fact, closer to 30 minutes later), I woke up to the nurse and the anesthesiologist wheeling me down the hall, repeating my name.  "It went really well," they reassured me.  

I had cramps.  They felt like moderate menstrual cramps.  The nurse asked me what my pain was on a scale of 1 to 10, I called it a 5.  She gave me some Tylenol, and that did the trick.  She had to help me get them in my mouth though, because wow - hand/eye coordination was not working.  I then sat in my recovery chair, munching on graham crackers, and drinking juice.  After about 30 minutes (but it felt more like 5 - the anesthesia really plays tricks on your internal clock), I was ready to get up and get dressed.  I was given a thorough discharge sheet (I would have to come back in one week for an HCG test, and every week after that till it dropped to zero) that explained what I should expect, and what would be considered abnormal.  It also admonished no sex, no swimming, no tampons till my HCG was negative.  I think some REs only make you wait 2 weeks.

I trudged out to the waiting room and Jeeves and I left and caught a cab home.  I was really tired.  I got into my jammies, got into bed, cuddled with my kitty cat, and promptly fell asleep.  I had very mild cramps off and on that day, and I took some ibuprofen for them.  I ate a little soup.  By evening, my appetite was normal.  I went to bed really early.

I was sad, but not nearly as sad as I had felt during the two weeks of ultrasound hell.  I was glad that it was done.

The next day, I felt fine.  I went for a walk and had a little cramping, but it was mild.  I went out to dinner with friends.  By Saturday I felt completely fine, physically, and Jeeves and I made sure to do fun things over the weekend.

I had a tiny bit of spotting for a day or two.  Then nothing.  About 5 days later, I started bleeding clots.  This happens to some women, whereas other women will have nothing.  It was upsetting, but there were no cramps with it (cramps and heavy bleeding can indicate that tissue was left behind).  I called my doctor, but she reassured me it was normal.  The clots stopped.  My HCG levels dropped.  Four weeks after the D&C, my HCG had finally dropped to negative, and a few days after that, I had a period.

The toughest part emotionally is that after a D&C (and this is true for natural or drug-induced miscarriage as well), your HCG plummets pretty quickly.  This sends your body into "hormone withdrawal" which in my case caused my clotty bleeding, but also caused me to get quite weepy over things that would not normally make me weepy.  It was even the subject of one of my first IF posts.  

This is just one woman's experience.  I know plenty of people who waited for a natural miscarriage and were happy they did, and I know plenty of people who had a drug-induced miscarriage and were happy they did.  There's no right or wrong answer here - just a shitty situation where we get to make a choice about how we want to handle it.  

In the end, I'm standing on the other side of this at 13w1d pregnant with a son.  I know it doesn't feel like it now, and it probably won't for quite awhile, but I really do believe that good things are ahead. For all of us.