I'm pretty sure I slept well until past noon after the delivery, and I really didn't care that I did. Somewhere along the way, I found myself past caring about a lot of things. I brushed my teeth, but that was about it. I was already overdue for a haircut and a shave when everything started, and by the time the delivery happened I was starting to get sort of a Jesus/Manson thing going on. I didn't care. I had tunnel vision. All I saw was S, and until she was done with the hardest thing she'd ever have to do, everything else could go hang.
All I remember about the next day was the silence and peace relative to the noise and chaos of the night before. Again, we were in a part of the wing away from all the parents of living children, and a falling leaf decal on our door marked us as someone who'd experienced a loss. S had gotten a transfusion because she lost quite a bit of blood during the delivery, and this meant she got almost no sleep, because they kept waking her up every couple of hours to change bags and get her vitals. Her family came back at some point, I remember them going to get me some lunch. The anesthesiology supervisor surveyed us for the quality of the epidural. We told him it wasn't great. I suspect dude got a C for that one.
A grief counselor came by and brought us teddy bears. We'd expressly asked that pastoral care not come by as they did the last time we were there - God talk wasn't going to do anything but piss us off. But, teddy bears? Really? There was one big one and one small one. Maybe it was mama bear and baby bear (no papa bear, apparently), but my first thought was one bear for each - Jacob was the big one and Joshua was the small one, because he died sooner and was smaller. I'm still not sure what the reasoning was, and we were both polite, but come on. Teddy bears. Except that as S and I started talking, we held onto the teddy bears, and it was actually pretty comforting. Soothing, even. Our cats weren't there to pet, and they're usually pretty good about knowing when we're upset. Our smaller one will sit right down on your chest or lap and curl up into a little ball, and our larger one will sit next to you, reaching out to touch you with one paw. We refer to this as the Paw of Concern, or Paw of Connection, or Paw of Reassurance, depending on the situation. I love our kitties.
I forget what the grief counselor said - yadda yadda sorry for your loss, blah blah grief, etc. She wasn't bad at her job or anything, I just couldn't care less what anyone had to say. I was in shock. I think the social worker went over postmortem options with us - did we want the photographs, the clothes in which they were photographed, measuring tapes, etc.? There's like a whole fucking industry around memory boxes and mementos. Find a need and fill it, I guess, but it sort of reminded me of all of the wedding magazines S stacked up around our apartment while we were planning our wedding. Just...how do you commodify something that's supposed to be transcendent? I mean, I see how it's done, but...I don't know. I'm sure people find solace in these boxes. I just don't need to see a fucking price list or discuss the options. I'm over here dying a little inside. I couldn't care less about a photo album or engraving or anything. I can't even being to imagine what it must be like to buy a casket.
We opted for photos, as any of you who read my wife's blog probably know. For me, it sort of felt like the best option I could endorse for the future with respect to the present. I too had read of people bathing and dressing and holding their stillborn children, and at that moment, I felt exactly like S describes in now. I knew if I held them or even saw them, I would probably snap and lose what little grip I had on my sanity. But I didn't want them to go unmemorialized or unremembered. We agreed that photos would be a good idea. I didn't want to see them right then - I've seen pictures of dead children before, and I know how deeply sad and horrifying they can be. I wanted to remember them as they were when they were alive, squirming around, working hard to grow, kicking each other in the head as I'm sure they would have as 8-year-old brothers. That was a very happy time, and I needed every little piece of happiness I could get. But I also knew that how I feel now is probably not how I'm going to feel 10 years from now. The 27-year-old me is nowhere near the 37-year-old me. Needs change, and the photos felt like a way to be ready for that.
I know S has looked at the photos, and from the way she describes it, it's about what I thought, and knowing what that probably means, I don't need to see them. I'm glad we have them, but I don't need to see them.
Then there was the remains. What a wonderful word. Did we want to bury them? Not here. Here isn't home. If we ever return here, it will be to visit friends, not the graves of our dead sons. We asked to have them cremated. I remember thinking back to when we had S's cat cremated, and how we had to pay extra to have her cremated separately. It offended me a little - dude, what, you think if I've gone to all this trouble, I won't care whose ashes I get? But I recognize that there are varying degrees of sentimentality about pets. So we sucked it up and paid the extra bucks. And I thought to myself "well, at least that won't be an issue now."
Except they asked us the same question.
Apparently, at this hospital, they do mass cremations and return ashes free of charge. There's just no guarantee they're your child's ashes. They're the ashes of many, many children. And politely? FUCK THAT. It's bad enough that my sons are dead, now you're going to tell me I have to give you money to ensure that it's their remains I get back? Of course I'm going to do that, and I'm going to wonder what this says about us as a culture the entire time.
I think I would have probably gotten even angrier, but again: Shock. It was one more thing on top of every other thing. I think there was some other paperwork or some shit, but honestly, everything I had was focused on trying to find something good and comforting to focus on, not because I wanted to prevent the inevitable freakout, but because I wanted something to make me hurt a little less, if only for a little bit. Whatever I had left was focused on S. We both spent the entire day on a rollercoaster - sadness, grief, dark humor, relief, exhaustion, comfort in each other. Whenever she had trouble, I played Director of Communications - I'd talk to S when we were alone, sort out what we wanted to do on any particular issue, and then tell people what we needed when necessary. I bitch and complain about all the work I was still having to do, but to be honest, part of me needed to do something. I needed a sense of control over something. I just wish people had been a little better about giving me room, or at least a little more aggressive about getting me to let go of some of it.
We'd gotten a friend to come over and move maternity clothes and baby books out of sight so when we got home S wouldn't have to look at them. On some level, being home felt comfortable, familiar - I could shower and eat and sleep in a real bed. On the other hand, it meant that the rest of our life was starting, and when the initial shock wore off, the rest was going to come down like a ton of bricks.
The day after the deliver, S's brother went back home. No, strike that - he went to go hang out with his fiancee (who was pissed that he'd been gone for five or six whole days) in Boston before returning home. Over a weekend. I'm still not really over that.
But that's how I got here. And everything from here on out is going to be about where "here" is and how I'm navigating the new normal, as a grieving parent, as an eggheaded academic, and as a man. I appreciate the attention and support, and hopefully this will become more of a dialogue than a monologue. Ask S - I can monologue with the best of them.
Showing posts with label background. Show all posts
Showing posts with label background. Show all posts
Tuesday, March 18, 2008
Monday, March 17, 2008
How I Got Here, Part 5: "There's Been A Misunderstanding..."
Our regular OB gets into town around this time. He opens up the office on New Year's Day to examine S - yet another ultrasound. His professional opinion is that S isn't retaining enough fluid to really help the baby grow - she's been leaking steadily the whole time. He thinks that at this point, we're just waiting for infection to set in. So we make arrangements. This means scheduling an appointment at our local hospital - they'll test S to make sure she can handle an epidural (stopped the heparin many days before), they'll give her the epidural, then they'll give her pitocin or misoprostol or cervidil to help cervical dilation and start labor. And all of our hard work, over like that. Or so we think.
Having come to some sense of closure, having resolved ourselves to a course of action, we get up early on the 2nd and go to the hospital. We get S ensconced in a room at the end of the hall, away from all the other moms-to-be. There's a flower on the door, which tells staff coming in that there's "been a loss" in this room. Meaning "for heaven's sake, no bright and chipper smiles and proud mama-and-papa talk."
Oh, but wait: Just as we're getting settled in, physically and emotionally, the nurse comes in and begins apologizing profusely. Apparently, there's been some misunderstanding, and the nurse manager hadn't been told that the OBs were going to have the nurses administer labor induction drugs. The nurse explains that she's not allowed to do that, and gets the nurse manager...
See, it's like this: In the benighted shithole of a state we call home, the Attorney General wrote an opinion saying that nurses doing exactly this - administering labor-inducing drugs in cases where the child is not viable - is too much like "practicing medicine." Specifically, too much like abortion. Which apparently makes the Baby Jesus cry. Ours is a small hospital - an attending and a bunch of nurses in the OB unit. The attending can't be available on an hourly basis to push the drugs, and the nurses are forbidden from doing it.
So we've prepared ourselves for the hardest thing we're ever going to have to do, and we're being told that we can't do it. Not here. Not now.
The nurse manager hates it too. The hospital wrote a letter of objection. Nurses have been doing this for years. Until some old man decides it's wrong. Doesn't matter. They can't do it.
So what option do we have? Back to the other hospital, which is a teaching hospital, and has tons of residents available to do what needs to be done. I've gotten smart by this point. I pack a change of clothes and a toothbrush. I think some books, too. Hospital time goes slow. Hurry up and wait.
When we get to the hospital, we're put in a triage room, S gets a contraction monitor, they draw some blood to make sure she can get the epidural, and in comes a resident who is apologetic and sensitive. He tells us that state law requires that we be counseled about "alternatives" before undergoing labor induction, as well as fill out forms indicating that we've been counseled and have undergone a mandatory 24-hour waiting period (you know, to make sure this isn't one of those rash, impulsive, spur-of-the-moment decisions). Bless them, they already had the forms filled out and we never saw them. The resident told us these were stupid, awful requirements, and he was sorry we even had to hear about them. After awhile (hospital time, so slow), another resident came in, all chipper and all smiles until she read the chart. She explained a little about what would happen, did some intake. We got moved to an examination room that doesn't look like it sees a lot of use. The staff are apologetic - they'll move us to another room as soon as they can, but they're getting slammed. And they are, I can hear it.
Specifically, I can hear a heart monitor in the next room over. Someones' healthy baby, heart beating away. In the other room (the one with whom we share a bathroom), there's a celebration going on. Another happy, healthy birth. I go out into the hall to get something to eat (already familiar with the Chinese takeout place in the food court) and heart monitors echo all the way down the hall. The sound of living children fills my head. None of them mine. None at all.
An anesthesiologist trainee puts in the epidural. Were I his instructor, I'd give him a B-, maybe a C+. Unfortunately, it was my wife on whom he was getting that grade. Apparently, she had a big nerve, and he kept hitting it. Under any other circumstances, I'd probably find it a little funny, in that "let's poke the brain and see what happens" kind of way. As it was, I was tired of seeing my wife in pain. Finally, after three or four tries, they get the catheter in. They have to keep rolling her onto her side to get the medicine to distribute evenly, because one side still isn't losing feeling. This will be important later.
The resident on our case wanted to treat it aggressively - basically, hammer S with huge doses of pitocin, get through it quickly. Which would be great, except the pitocin, over several hours (hospital time, so slow, time standing still in a room with no windows), didn't take. Contractions ramped up a little, then plateaued. No dilation. Hours. Shift changes, new doctor takes over. S gets some phenergen for nausea and to knock her out. While she's asleep, I talk to her family. They're trying to figure out where to go (the hospital's about 45 minutes away from where we live), do they stay here, do they go back, they want to get back quickly after it happens. Brother-in-law keeps whining about how with all the talk they could be halfway back to the hotel by now and I wonder for the 837,000th time why the fuck he even came. At best he falls asleep on the couch and isn't an active pain in the ass. I take charge (again, they're here for me too) and send sister and brother-in-law back to their hotel. Brother and father get a room at a place near the hospital.
This is when things start to get blurry. I think maybe an hour or two after the family left, the new doctor started administering cervidil, which worked fast. Contractions, dilation, and it becomes immediately apparent that the epidural didn't quite take. S can feel the contractions up one side of her body, and she's screaming. She's in so much physical and emotional pain, there are nurses and a doctor, the whole thing strikes me as a hideous parody of birth - she's going through all the agony and effort of labor to deliver dead and dying children. I hold her hand, I tell her to push, I stroke her head, just like we would if our children were being born alive. I keep telling her that I'm there, that I'm not going anywhere. I have no idea how long it took, all I could see was her and all I could was hope it would be over soon.
Once the boys were delivered, the nurses took them away to photograph them for us and keep them so we could see them the next day if we wished. I waited until S had fallen asleep and sat back in a recliner, and it occurred to me that I could close my eyes if I wanted. I texted S's father and let myself fall back into the dark and quiet.
I think at some point her family came through, but I was completely out of it. At least, until they started delivering the placenta, which was I think an hour or two later. I slowly became aware that S was screaming again, and it was like something from a nightmare. All the lights were out except for ones around her, throwing sharp, stark shadows everywhere. I could see a lot of blood on the doctor's arms and on the sheets, and I was so tired that I couldn't move. All I could do was watch helplessly. I just couldn't move. S was so out of it from pain and grief that she was asking for Tylenol, something, anything for the pain. The doctor asked if she was sure she wanted Tylenol, and S just wanted something for the pain. The doctor asked for 3 of morphine, and then S screamed again and she upped it to 5. I didn't relax again until I heard S start snoring. I knew she was asleep then, and if she was asleep she was no longer in pain. I've never been so happy to hear her snore in my life. Such small things.
A nurse gave S a sponge bath and I couldn't get over how small and vulnerable she looked as the nurse cleaned her up. How surrendered she was to the care of another. She looked like a child. The horrible ironies just kept coming. At around 6am or so they got us moved to another room, a nicer room in the other wing. The nurse was someone who'd seen us when we were there on the 26th and 27th, and she'd already made up the couch bed for me. She said to S "when I saw it was you, I made up the couch because I knew your husband would be right by your side." I was touched. How could I be anything but? How was this anything but us, together, side by side? How does anyone else get through this?
I kept it together long enough to change into pajamas and brush my teeth, and collapsed on the couch bed. I don't think I woke up again until around noon.
Next time: The rest is silence.
Having come to some sense of closure, having resolved ourselves to a course of action, we get up early on the 2nd and go to the hospital. We get S ensconced in a room at the end of the hall, away from all the other moms-to-be. There's a flower on the door, which tells staff coming in that there's "been a loss" in this room. Meaning "for heaven's sake, no bright and chipper smiles and proud mama-and-papa talk."
Oh, but wait: Just as we're getting settled in, physically and emotionally, the nurse comes in and begins apologizing profusely. Apparently, there's been some misunderstanding, and the nurse manager hadn't been told that the OBs were going to have the nurses administer labor induction drugs. The nurse explains that she's not allowed to do that, and gets the nurse manager...
See, it's like this: In the benighted shithole of a state we call home, the Attorney General wrote an opinion saying that nurses doing exactly this - administering labor-inducing drugs in cases where the child is not viable - is too much like "practicing medicine." Specifically, too much like abortion. Which apparently makes the Baby Jesus cry. Ours is a small hospital - an attending and a bunch of nurses in the OB unit. The attending can't be available on an hourly basis to push the drugs, and the nurses are forbidden from doing it.
So we've prepared ourselves for the hardest thing we're ever going to have to do, and we're being told that we can't do it. Not here. Not now.
The nurse manager hates it too. The hospital wrote a letter of objection. Nurses have been doing this for years. Until some old man decides it's wrong. Doesn't matter. They can't do it.
So what option do we have? Back to the other hospital, which is a teaching hospital, and has tons of residents available to do what needs to be done. I've gotten smart by this point. I pack a change of clothes and a toothbrush. I think some books, too. Hospital time goes slow. Hurry up and wait.
When we get to the hospital, we're put in a triage room, S gets a contraction monitor, they draw some blood to make sure she can get the epidural, and in comes a resident who is apologetic and sensitive. He tells us that state law requires that we be counseled about "alternatives" before undergoing labor induction, as well as fill out forms indicating that we've been counseled and have undergone a mandatory 24-hour waiting period (you know, to make sure this isn't one of those rash, impulsive, spur-of-the-moment decisions). Bless them, they already had the forms filled out and we never saw them. The resident told us these were stupid, awful requirements, and he was sorry we even had to hear about them. After awhile (hospital time, so slow), another resident came in, all chipper and all smiles until she read the chart. She explained a little about what would happen, did some intake. We got moved to an examination room that doesn't look like it sees a lot of use. The staff are apologetic - they'll move us to another room as soon as they can, but they're getting slammed. And they are, I can hear it.
Specifically, I can hear a heart monitor in the next room over. Someones' healthy baby, heart beating away. In the other room (the one with whom we share a bathroom), there's a celebration going on. Another happy, healthy birth. I go out into the hall to get something to eat (already familiar with the Chinese takeout place in the food court) and heart monitors echo all the way down the hall. The sound of living children fills my head. None of them mine. None at all.
An anesthesiologist trainee puts in the epidural. Were I his instructor, I'd give him a B-, maybe a C+. Unfortunately, it was my wife on whom he was getting that grade. Apparently, she had a big nerve, and he kept hitting it. Under any other circumstances, I'd probably find it a little funny, in that "let's poke the brain and see what happens" kind of way. As it was, I was tired of seeing my wife in pain. Finally, after three or four tries, they get the catheter in. They have to keep rolling her onto her side to get the medicine to distribute evenly, because one side still isn't losing feeling. This will be important later.
The resident on our case wanted to treat it aggressively - basically, hammer S with huge doses of pitocin, get through it quickly. Which would be great, except the pitocin, over several hours (hospital time, so slow, time standing still in a room with no windows), didn't take. Contractions ramped up a little, then plateaued. No dilation. Hours. Shift changes, new doctor takes over. S gets some phenergen for nausea and to knock her out. While she's asleep, I talk to her family. They're trying to figure out where to go (the hospital's about 45 minutes away from where we live), do they stay here, do they go back, they want to get back quickly after it happens. Brother-in-law keeps whining about how with all the talk they could be halfway back to the hotel by now and I wonder for the 837,000th time why the fuck he even came. At best he falls asleep on the couch and isn't an active pain in the ass. I take charge (again, they're here for me too) and send sister and brother-in-law back to their hotel. Brother and father get a room at a place near the hospital.
This is when things start to get blurry. I think maybe an hour or two after the family left, the new doctor started administering cervidil, which worked fast. Contractions, dilation, and it becomes immediately apparent that the epidural didn't quite take. S can feel the contractions up one side of her body, and she's screaming. She's in so much physical and emotional pain, there are nurses and a doctor, the whole thing strikes me as a hideous parody of birth - she's going through all the agony and effort of labor to deliver dead and dying children. I hold her hand, I tell her to push, I stroke her head, just like we would if our children were being born alive. I keep telling her that I'm there, that I'm not going anywhere. I have no idea how long it took, all I could see was her and all I could was hope it would be over soon.
Once the boys were delivered, the nurses took them away to photograph them for us and keep them so we could see them the next day if we wished. I waited until S had fallen asleep and sat back in a recliner, and it occurred to me that I could close my eyes if I wanted. I texted S's father and let myself fall back into the dark and quiet.
I think at some point her family came through, but I was completely out of it. At least, until they started delivering the placenta, which was I think an hour or two later. I slowly became aware that S was screaming again, and it was like something from a nightmare. All the lights were out except for ones around her, throwing sharp, stark shadows everywhere. I could see a lot of blood on the doctor's arms and on the sheets, and I was so tired that I couldn't move. All I could do was watch helplessly. I just couldn't move. S was so out of it from pain and grief that she was asking for Tylenol, something, anything for the pain. The doctor asked if she was sure she wanted Tylenol, and S just wanted something for the pain. The doctor asked for 3 of morphine, and then S screamed again and she upped it to 5. I didn't relax again until I heard S start snoring. I knew she was asleep then, and if she was asleep she was no longer in pain. I've never been so happy to hear her snore in my life. Such small things.
A nurse gave S a sponge bath and I couldn't get over how small and vulnerable she looked as the nurse cleaned her up. How surrendered she was to the care of another. She looked like a child. The horrible ironies just kept coming. At around 6am or so they got us moved to another room, a nicer room in the other wing. The nurse was someone who'd seen us when we were there on the 26th and 27th, and she'd already made up the couch bed for me. She said to S "when I saw it was you, I made up the couch because I knew your husband would be right by your side." I was touched. How could I be anything but? How was this anything but us, together, side by side? How does anyone else get through this?
I kept it together long enough to change into pajamas and brush my teeth, and collapsed on the couch bed. I don't think I woke up again until around noon.
Next time: The rest is silence.
How I Got Here, Part 4: "We've Made Our Decision."
So we get back home and settle in. S's father, sister, and brother-in-law are at a nearby hotel, but there's at least one of them with us all the time. On some level, I think we're still in shock. Something about being in hospitals makes it hard to keep track of time. It's a little disorienting. We come home, and I walk S upstairs to the bedroom and get her tucked in. No moving more than she has to, check her temperature every 6 hours, she's like an invalid. I walk into our kitchen to get something to drink and am greeted by a spray of broken dishes everywhere and two very frightened cats. Apparently, while we were at the hospital, one of the shelves in a kitchen cabinet broke, and the dishes and mugs on it flew out. Normally, I would probably flip out - I really liked these dishes and the cats seem really freaked out. We've been gone for a couple of days and who knows when this happened. However, all I can muster is dull surprise. One of our babies is dead, the other may die, so sure, why not come home to a kitchen full of smashed dishes? As long as Christmas vacation is all about chaos, fear, and everything going to shit, why not smashed dishes too?
I'm glad S's family is here for this. I love my parents, but I'm not sure "good in a crisis" is on their list of assets. S's family took care of her mom in her last days with cancer, they know how to organize and delegate and take care of business when someone's health is on the line. Mostly. More on that in awhile.
So finally at around 10 or 11 or so her family goes back to their hotel. We go to bed, I try to spoon her like I always do, but she's a fragile thing now. She's uncertainty embodied. Infection, premature contractions, more leaking, I'm afraid to hold her. Afraid of what's going to happen in the middle of the night. S's mother started dying in the middle of the night, though it was morning when she finally went. This felt like the same kind of vigil. Something could happen at any time. Felt like it did when S's beloved 15-year-old cat was dying of lymphoma and having seizures. Snap awake in the middle of the night because something bad is happening and demands action. Sleep becomes a minefield. Honestly, I can't remember how I slept. I might have been so exhausted that I slept fine.
Sure enough, we wake up the morning of the 28th and S has another huge gush of fluid and some contractions. So early in the morning, back to the ER. Another day on hospital time. Contractions never get worse, fluid continues to leak, nothing to be done, back home we go.
("Nothing to be done" just occurred to me now, it appears throughout the play Waiting for Godot, a play about two people waiting for someone who should arrive, but hasn't, or maybe won't. How very apropos.)
For the next three days, we wait. We escort S gingerly from upstairs down to the couch in the living room. Temperature every 6 hours. Watching, waiting, waiting, waiting, waiting.
S's family tries to look out for me, there's a lot of "we're here for both of you", but they're here for her. Part of it is the family dynamic - she's the middle child, feels everything, does a lot of crying, there's that sense that she needs to be protected. Never mind all the hard, ugly shit she had to do for her mother. I know she's tough. I believe in her. I'm worried about her, I find myself playing host, fixing people lunch. I think I'm trying to outrun it. Her father keeps getting on my case about our litterboxes. He's afraid S will inhale particulate matter and get some hideous infection, something no doctor at any point anywhere ever has even remotely considered a problem. There are all kinds of other things that could use doing, but he just won't shut up about it. I know he's afraid of losing a grandson and a daughter, but I'm afraid of losing a son and a wife. And yet, I'm apparently the one get bitched at. I know he's trying to protect her, but it's hard for me to keep a civil tongue in my head. S's sister is super-helpful, but her husband is pretty high-maintenance, so she's dividing her time between looking after S, helping me, and looking after him. Somehow I find myself doing a lot of the work that I think they're supposed to be doing for me.
Then there's the whole issue of who gets to know what and when. S's father takes care of his mother-in-law, who lives in a retirement community. No way in hell does she get to find out what we're going through just yet, but Dad is explaining his relative absence on a cold. S's younger brother is there to look in on her, but he pitches a fit over having to pull grandmother duty instead of being where the action is. So S's uncle comes out (from, for Chrissakes, New Mexico) to the East coast to look after her so brother can soothe his feelings of being left out. This is shit for which I have exactly zero patience at this point, and it's beginning to feel at points like people aren't here so much for us as to meet their own needs. My family wants to come out too, but we don't need everyone out here. So do they want to help us, or do they want to feel like they're doing something? Their needs and fears and insecurities are, in the words of a TV show I like, an NMFP. Not My Fucking Problem. S's brother gets into town, sulks when people don't pay attention to him, cleans our kitchen and our car, and it's appreciated, really it is, but I wish he'd asked me where dishes went when he cleaned the kitchen. I found myself hunting for specific dishes and pieces of cookware for weeks after that. But he meant well. When I get a break from what feels like herding the people who are there to help, S and I talk about our options.
To say it's tough is a huge understatement. We've been talking about the worst-case scenario ever since Christmas. The price for expectant management is the ever-present threat of infection, and as bad as losing both of my sons seems, losing both of my sons and my wife is utterly terrifying. And yet, here we are, the future of our remaining son in our hands. It used to be when S would ask me what I wanted for some gift-giving occasion, I'd say "I want to decide who lives and who dies." And now that's exactly what I have to do.
The entire experience has to this point been a mixture of aching fear and removed amazement. Even as S and I decide the fate of our remaining son, there's one part of me screaming inside that I don't want to lose anyone else, and another part thinking "holy shit, I am actually being called upon to make this decision. Some people will go their entire lives and never have to consider this decision. Holy shit."
S and I come to a decision on New Year's Eve. We've gone back and forth, and it seems like our son's chances are bleak. We have to avoid any more complications for a month to even get to the bleeding edge of viability, when the really awful hard part starts, and the chance of having a healthy child are small. To go through all of this for another month at least, just to watch him suffer, in pain in the NICU, hooked up to machines, struggling to breathe...it's too much. What kind of life is that? What kind of life will he have? We were okay with the idea of raising a child with Down's, but that's more of a known quantity. Are we capable of spending the rest of our lives taking care of a disabled boy? Are we those kind of parents? We're relying on a months'-plus worth of things to go right, just for a shit chance at a hard life. On New Year's Eve, we gather S's family at the house and tell them that we've decided to pursue active management.
Next time: We know what we have to do. Being able to do it is a whole other matter.
I'm glad S's family is here for this. I love my parents, but I'm not sure "good in a crisis" is on their list of assets. S's family took care of her mom in her last days with cancer, they know how to organize and delegate and take care of business when someone's health is on the line. Mostly. More on that in awhile.
So finally at around 10 or 11 or so her family goes back to their hotel. We go to bed, I try to spoon her like I always do, but she's a fragile thing now. She's uncertainty embodied. Infection, premature contractions, more leaking, I'm afraid to hold her. Afraid of what's going to happen in the middle of the night. S's mother started dying in the middle of the night, though it was morning when she finally went. This felt like the same kind of vigil. Something could happen at any time. Felt like it did when S's beloved 15-year-old cat was dying of lymphoma and having seizures. Snap awake in the middle of the night because something bad is happening and demands action. Sleep becomes a minefield. Honestly, I can't remember how I slept. I might have been so exhausted that I slept fine.
Sure enough, we wake up the morning of the 28th and S has another huge gush of fluid and some contractions. So early in the morning, back to the ER. Another day on hospital time. Contractions never get worse, fluid continues to leak, nothing to be done, back home we go.
("Nothing to be done" just occurred to me now, it appears throughout the play Waiting for Godot, a play about two people waiting for someone who should arrive, but hasn't, or maybe won't. How very apropos.)
For the next three days, we wait. We escort S gingerly from upstairs down to the couch in the living room. Temperature every 6 hours. Watching, waiting, waiting, waiting, waiting.
S's family tries to look out for me, there's a lot of "we're here for both of you", but they're here for her. Part of it is the family dynamic - she's the middle child, feels everything, does a lot of crying, there's that sense that she needs to be protected. Never mind all the hard, ugly shit she had to do for her mother. I know she's tough. I believe in her. I'm worried about her, I find myself playing host, fixing people lunch. I think I'm trying to outrun it. Her father keeps getting on my case about our litterboxes. He's afraid S will inhale particulate matter and get some hideous infection, something no doctor at any point anywhere ever has even remotely considered a problem. There are all kinds of other things that could use doing, but he just won't shut up about it. I know he's afraid of losing a grandson and a daughter, but I'm afraid of losing a son and a wife. And yet, I'm apparently the one get bitched at. I know he's trying to protect her, but it's hard for me to keep a civil tongue in my head. S's sister is super-helpful, but her husband is pretty high-maintenance, so she's dividing her time between looking after S, helping me, and looking after him. Somehow I find myself doing a lot of the work that I think they're supposed to be doing for me.
Then there's the whole issue of who gets to know what and when. S's father takes care of his mother-in-law, who lives in a retirement community. No way in hell does she get to find out what we're going through just yet, but Dad is explaining his relative absence on a cold. S's younger brother is there to look in on her, but he pitches a fit over having to pull grandmother duty instead of being where the action is. So S's uncle comes out (from, for Chrissakes, New Mexico) to the East coast to look after her so brother can soothe his feelings of being left out. This is shit for which I have exactly zero patience at this point, and it's beginning to feel at points like people aren't here so much for us as to meet their own needs. My family wants to come out too, but we don't need everyone out here. So do they want to help us, or do they want to feel like they're doing something? Their needs and fears and insecurities are, in the words of a TV show I like, an NMFP. Not My Fucking Problem. S's brother gets into town, sulks when people don't pay attention to him, cleans our kitchen and our car, and it's appreciated, really it is, but I wish he'd asked me where dishes went when he cleaned the kitchen. I found myself hunting for specific dishes and pieces of cookware for weeks after that. But he meant well. When I get a break from what feels like herding the people who are there to help, S and I talk about our options.
To say it's tough is a huge understatement. We've been talking about the worst-case scenario ever since Christmas. The price for expectant management is the ever-present threat of infection, and as bad as losing both of my sons seems, losing both of my sons and my wife is utterly terrifying. And yet, here we are, the future of our remaining son in our hands. It used to be when S would ask me what I wanted for some gift-giving occasion, I'd say "I want to decide who lives and who dies." And now that's exactly what I have to do.
The entire experience has to this point been a mixture of aching fear and removed amazement. Even as S and I decide the fate of our remaining son, there's one part of me screaming inside that I don't want to lose anyone else, and another part thinking "holy shit, I am actually being called upon to make this decision. Some people will go their entire lives and never have to consider this decision. Holy shit."
S and I come to a decision on New Year's Eve. We've gone back and forth, and it seems like our son's chances are bleak. We have to avoid any more complications for a month to even get to the bleeding edge of viability, when the really awful hard part starts, and the chance of having a healthy child are small. To go through all of this for another month at least, just to watch him suffer, in pain in the NICU, hooked up to machines, struggling to breathe...it's too much. What kind of life is that? What kind of life will he have? We were okay with the idea of raising a child with Down's, but that's more of a known quantity. Are we capable of spending the rest of our lives taking care of a disabled boy? Are we those kind of parents? We're relying on a months'-plus worth of things to go right, just for a shit chance at a hard life. On New Year's Eve, we gather S's family at the house and tell them that we've decided to pursue active management.
Next time: We know what we have to do. Being able to do it is a whole other matter.
Saturday, March 15, 2008
How I Got Here, Part 3: "I Have Some Bad News..."
I came back to the hospital the next morning, and they hooked S up to a fetal heart monitor - which was only finding one heartbeat. I tried not to let it bother me too much, partially because I have a tendency to get really anxious really quickly, a tendency I've worked for many years to control. Also, S was going to get upset enough for both of us, I knew that. So I tried to remain optimistic - after all, it was a pain in the ass to find one of the heartbeats under the best of circumstances. To my mind, it was too early to start panicking. In retrospect, maybe part of it was denial. The OB brought in a crappy mobile ultrasound machine and tried to find the second heartbeat that way. Still no dice. We waited, and waited, and watched TV, and waited for the radiologist. This was a state with which I was to become very familiar over the next week or so. Sitting on a plasticky hospital room couch, watching the most innocuous thing we could on cable.
In the time it took the radiologist to get set up for us, it had started to sink in that it was possible one of our children was dead. I don't think either of us wanted to say anything, because once it was said out loud, it became real. Somewhere in the back of my head, I started preparing myself for the possibility. Our regular OB was away on vacation, hell, everyone was away on vacation. It was the day after Christmas. The town was empty and quiet. It felt like we were trapped in some time bubble where everything went slowly. It was starting to occur to us that this might not be as simple or nonthreatening as we'd hoped.
The radiologist came in and brought the really good ultrasound machine up to our room. The tech was someone who'd done a transvaginal on S during a previous cycle that ended in a chemical pregnancy. During the ultrasound, S had an ovarian cyst rupture, and my only other memory of that day was her out in the hall outside the ultrasound room, screaming in pain and me trying to find the nurse who'd said "I'll be right back with something" several minutes before. Fortunately, he did a much better job this time.
Unfortunately, the news wasn't good. There wasn't a second heartbeat, there wasn't movement. Baby B, as he was known at this time, was dead. Our other boy still had a nice strong heartbeat, but amniotic fluid was a concern. The OB came back to the room after looking at the scans. He'd passed them along to our perinatologist in a neighboring city, and their recommendation was to get S there right away to get her into a larger hospital with a high-risk OB unit. Without a chance to shower or change, we were off.
Checking in was a hoot - the reception desk was in a small room already crowded with people, and we felt like we were sitting on a ticking time bomb, like we could lose our other baby at any second. Even better, in came a woman who was already in the throes of labor - breathing and everything. So no, that wasn't too upsetting. They moved S into an examination room, hooked her up to a contraction monitor. S had been having mild contractions the whole time, which added to the whole time-bomb feeling, like she could deliver at any moment. A shitload of doctors came to talk to us - obstetricians, our perinatologist, and they scheduled another ultrasound and an appointment with a neonatologist.
Basically, the diagnosis was premature rupture of the amniotic membrane. Our boys each had their own sac, their own placenta. So at least one sac had ruptured, and the other was leaking. So they laid out our options. This is where the euphemisms started flying fast and thick.
Three obstetricians came in to talk to us. One option, they said, was "expectant management." In essence, we could go home, S could go on bedrest, taking her temperature 4 times a day to make sure infection doesn't set in, and hope we could make it to 24 weeks. We were at 20 weeks when this happened, so that meant a whole month of pins and needles, bedrest and remaining ever vigilant for infection. And what, pray tell, would that month of hell buy us? A 50% chance that our living baby would survive birth. Yay? The other option was "active management", which to me sounds like some seminar you send Brad from the Chicago office to as a way to improve his vertical effectiveness at empowering employee resources to go proactive on deliverables or some shit. (There's a reason I'm in academia.) This was just a fancy way of saying that we could induce labor, which would straight-up kill our living child, because at 20 weeks, he wasn't going to be capable of breathing on his own.
Then in comes our perinatologist. He kind of rubs S the wrong way, but I can relate to him. He's not quite House, but they share some common DNA. He thinks expectant management could work - S is still losing amniotic fluid, but he thinks as long as she keeps producing it we're actually in good shape, because it's essentially carrying bacteria away from the babies, which also makes infection less likely. He thinks there's enough for the surviving baby to develop lungs. He doesn't tell us what to do, just that he thinks we have a choice. We still need to get another ultrasound and talk to a neonatologist. I'm on my cell phone to friends and family, leaving messages, updating people. We get moved to a nicer room.
I will say this - the rooms at this hospital are sweet. S gets the usual hospital bed, I have my fold-out couch bed and a recliner. It's amazing how quickly small things become important. S and I talk about how we're going to handle this. S is having trouble talking about it without crying, which is going to make it tough to communicate with the staff. I don't really cry that much. Which is a topic for another post. I ask her if she wants me to do the talking when she can't, and she says yes. So I am now Director of Communications for Team Married.
S's father has come back into town - he basically got home from one visit, and turned around and came right back out. Her sister is on the red-eye from the West Coast. We don't know it yet, but we're in for a long wait.
Now, S and I refer to it as "hospital time" - nothing happens quickly. It takes us forever to get another ultrasound, which ends up telling us nothing. Not only does it end up telling us nothing, but it only does so after an extended wait in a lobby filled with mothers and squealing children. Constant reminders all around us. The tech points out our living baby's strong heartbeat, and it kills me a little inside. We're having to seriously consider letting them both go, and the tech is not making it one bit easier. The doctor who looks at the scans has no discernable personality, and it's a little disconcerting. Maybe one day, all of us will have our ultrasounds read by androids, but right now it's a little weird.
We spend the better part of the day going back and forth - a month is a long time, and 50% isn't great odds-wise, but if it means a living baby, that's the important part, right?
And then we speak to the neonatologist. This is around 7pm on the 27th. S's father, sister, and brother-in-law are there. All the nurses and residents have been very apologetic about the wait, but the NICU has apparently been getting hammered. When we see the neonatologist, we can tell it isn't a lie. She looks really strung out and really sad. How much of it is the death she's seen and how much of it is knowing our situation better than we do I don't know. But she lays out what that 50% survival entails for our child.
If our baby survives birth...if...there's brain bleeds, respiratory problems, lifetime disabilities. About four months in the NICU hooked up to machines. Will he be okay? Who knows? Every day will be a struggle. And that's if we can make it another month without infection setting in, without premature labor, without anything else going wrong, because everything else has been going absolutely fucking swimmingly so far.
We decide to try expectant management, After a day of making phone calls that all begin "I have some bad news...", a little hope helps.
S's father-in-law drives us home, and his driving is more terrifying than anything else we've faced that day, in that moment.
Next time: Yes, but no, but yes, but no.
In the time it took the radiologist to get set up for us, it had started to sink in that it was possible one of our children was dead. I don't think either of us wanted to say anything, because once it was said out loud, it became real. Somewhere in the back of my head, I started preparing myself for the possibility. Our regular OB was away on vacation, hell, everyone was away on vacation. It was the day after Christmas. The town was empty and quiet. It felt like we were trapped in some time bubble where everything went slowly. It was starting to occur to us that this might not be as simple or nonthreatening as we'd hoped.
The radiologist came in and brought the really good ultrasound machine up to our room. The tech was someone who'd done a transvaginal on S during a previous cycle that ended in a chemical pregnancy. During the ultrasound, S had an ovarian cyst rupture, and my only other memory of that day was her out in the hall outside the ultrasound room, screaming in pain and me trying to find the nurse who'd said "I'll be right back with something" several minutes before. Fortunately, he did a much better job this time.
Unfortunately, the news wasn't good. There wasn't a second heartbeat, there wasn't movement. Baby B, as he was known at this time, was dead. Our other boy still had a nice strong heartbeat, but amniotic fluid was a concern. The OB came back to the room after looking at the scans. He'd passed them along to our perinatologist in a neighboring city, and their recommendation was to get S there right away to get her into a larger hospital with a high-risk OB unit. Without a chance to shower or change, we were off.
Checking in was a hoot - the reception desk was in a small room already crowded with people, and we felt like we were sitting on a ticking time bomb, like we could lose our other baby at any second. Even better, in came a woman who was already in the throes of labor - breathing and everything. So no, that wasn't too upsetting. They moved S into an examination room, hooked her up to a contraction monitor. S had been having mild contractions the whole time, which added to the whole time-bomb feeling, like she could deliver at any moment. A shitload of doctors came to talk to us - obstetricians, our perinatologist, and they scheduled another ultrasound and an appointment with a neonatologist.
Basically, the diagnosis was premature rupture of the amniotic membrane. Our boys each had their own sac, their own placenta. So at least one sac had ruptured, and the other was leaking. So they laid out our options. This is where the euphemisms started flying fast and thick.
Three obstetricians came in to talk to us. One option, they said, was "expectant management." In essence, we could go home, S could go on bedrest, taking her temperature 4 times a day to make sure infection doesn't set in, and hope we could make it to 24 weeks. We were at 20 weeks when this happened, so that meant a whole month of pins and needles, bedrest and remaining ever vigilant for infection. And what, pray tell, would that month of hell buy us? A 50% chance that our living baby would survive birth. Yay? The other option was "active management", which to me sounds like some seminar you send Brad from the Chicago office to as a way to improve his vertical effectiveness at empowering employee resources to go proactive on deliverables or some shit. (There's a reason I'm in academia.) This was just a fancy way of saying that we could induce labor, which would straight-up kill our living child, because at 20 weeks, he wasn't going to be capable of breathing on his own.
Then in comes our perinatologist. He kind of rubs S the wrong way, but I can relate to him. He's not quite House, but they share some common DNA. He thinks expectant management could work - S is still losing amniotic fluid, but he thinks as long as she keeps producing it we're actually in good shape, because it's essentially carrying bacteria away from the babies, which also makes infection less likely. He thinks there's enough for the surviving baby to develop lungs. He doesn't tell us what to do, just that he thinks we have a choice. We still need to get another ultrasound and talk to a neonatologist. I'm on my cell phone to friends and family, leaving messages, updating people. We get moved to a nicer room.
I will say this - the rooms at this hospital are sweet. S gets the usual hospital bed, I have my fold-out couch bed and a recliner. It's amazing how quickly small things become important. S and I talk about how we're going to handle this. S is having trouble talking about it without crying, which is going to make it tough to communicate with the staff. I don't really cry that much. Which is a topic for another post. I ask her if she wants me to do the talking when she can't, and she says yes. So I am now Director of Communications for Team Married.
S's father has come back into town - he basically got home from one visit, and turned around and came right back out. Her sister is on the red-eye from the West Coast. We don't know it yet, but we're in for a long wait.
Now, S and I refer to it as "hospital time" - nothing happens quickly. It takes us forever to get another ultrasound, which ends up telling us nothing. Not only does it end up telling us nothing, but it only does so after an extended wait in a lobby filled with mothers and squealing children. Constant reminders all around us. The tech points out our living baby's strong heartbeat, and it kills me a little inside. We're having to seriously consider letting them both go, and the tech is not making it one bit easier. The doctor who looks at the scans has no discernable personality, and it's a little disconcerting. Maybe one day, all of us will have our ultrasounds read by androids, but right now it's a little weird.
We spend the better part of the day going back and forth - a month is a long time, and 50% isn't great odds-wise, but if it means a living baby, that's the important part, right?
And then we speak to the neonatologist. This is around 7pm on the 27th. S's father, sister, and brother-in-law are there. All the nurses and residents have been very apologetic about the wait, but the NICU has apparently been getting hammered. When we see the neonatologist, we can tell it isn't a lie. She looks really strung out and really sad. How much of it is the death she's seen and how much of it is knowing our situation better than we do I don't know. But she lays out what that 50% survival entails for our child.
If our baby survives birth...if...there's brain bleeds, respiratory problems, lifetime disabilities. About four months in the NICU hooked up to machines. Will he be okay? Who knows? Every day will be a struggle. And that's if we can make it another month without infection setting in, without premature labor, without anything else going wrong, because everything else has been going absolutely fucking swimmingly so far.
We decide to try expectant management, After a day of making phone calls that all begin "I have some bad news...", a little hope helps.
S's father-in-law drives us home, and his driving is more terrifying than anything else we've faced that day, in that moment.
Next time: Yes, but no, but yes, but no.
Friday, March 14, 2008
How I Got Here, Part 2: "Well, I Don't Have A Crystal Ball..."
Leading up to the holidays, all of the disruptions we'd experienced were becoming almost routine. S uses the phrase "the new normal", and I think this is about the time I started to understand what that means. It was perfectly routine for S to be: a) throwing up, b) feeling like she had to throw up, or c) completely without appetite because she'd just finished throwing up. We had cans of Ensure and SlimFast in the refrigerator, what she could and couldn't eat changed every week, trips to the hospital for IV fluids happened every couple of weeks, so regularly that I came to regard them like I would one of her night classes. No big thing, she'll be home tomorrow morning. I got used to fixing meals for myself alone. No big deal. It's the new normal.
Ordinarily, this would be painful and difficult and cause for tremendous concern and upset, but we were having twins. We couldn't get a straight answer on the sickness thing. Some people swore they'd go away after 20 weeks or so, others said it was just the first trimester, yet others said they were sick the whole time. Great. Still, we were chin up and enduring, because we were having babies.
That all changed on Christmas day.
The Christmas break was going to be less eventful than average, I thought, because we weren't going anywhere (what with the puking and all) . My father-in-law had just been to visit, and I spent Christmas Eve at school catching up on some work. I thought we'd have a quiet Christmas - S had just started to get her appetite back around the time her father was here, so I figured we'd sleep in, then I'd make us breakfast (I'm kind of the cook in the relationship) and we'd watch some movies, snuggle on the couch, enjoy the quiet.
Except that when S got out of bed, there was a huge gush of fluid. No debating, no mulling or pondering, we threw on clothes and headed to the emergency room.
Of course, it's Christmas, so pretty much nobody is there. We're sitting in the waiting room, getting more anxious every second. Everything is suddenly very tenuous, as if our entire lives are teetering on the edge of a steep cliff. Once we're finally admitted to triage, the ER doctor does a quick Doppler scan and hears one heartbeat. But the pH test seems to indicate it isn't amniotic fluid, and the Doppler scan is a shitty little thing, and our boys had already demonstrated a talent for squirming around to avoid detection. So I wasn't terrified just yet. The obstetrician on duty was, like, our least favorite OB in our very small town. Very old-school, silver-haired guy with some problems in the bedside manner type area. (He couldn't find a heartbeat on our friends' baby at 8 weeks, so his first move was to give her pamphlets on miscarriage. That particular miscarriage is coming up on 2 years old.) Exactly the kind of doctor you can imagine telling an off-color joke to some golf buddies at the country club. The radiologist would be in tomorrow, he said. I spent the day with S, then went home to change and shower and get some sleep. I was still the picture of optimism at this point - probably a high leak, it'll get better. Wasn't amniotic fluid. All will be better. We're still having babies. Right?
Tune in tomorrow, when the entire medical staff pretty much says "wrong."
Ordinarily, this would be painful and difficult and cause for tremendous concern and upset, but we were having twins. We couldn't get a straight answer on the sickness thing. Some people swore they'd go away after 20 weeks or so, others said it was just the first trimester, yet others said they were sick the whole time. Great. Still, we were chin up and enduring, because we were having babies.
That all changed on Christmas day.
The Christmas break was going to be less eventful than average, I thought, because we weren't going anywhere (what with the puking and all) . My father-in-law had just been to visit, and I spent Christmas Eve at school catching up on some work. I thought we'd have a quiet Christmas - S had just started to get her appetite back around the time her father was here, so I figured we'd sleep in, then I'd make us breakfast (I'm kind of the cook in the relationship) and we'd watch some movies, snuggle on the couch, enjoy the quiet.
Except that when S got out of bed, there was a huge gush of fluid. No debating, no mulling or pondering, we threw on clothes and headed to the emergency room.
Of course, it's Christmas, so pretty much nobody is there. We're sitting in the waiting room, getting more anxious every second. Everything is suddenly very tenuous, as if our entire lives are teetering on the edge of a steep cliff. Once we're finally admitted to triage, the ER doctor does a quick Doppler scan and hears one heartbeat. But the pH test seems to indicate it isn't amniotic fluid, and the Doppler scan is a shitty little thing, and our boys had already demonstrated a talent for squirming around to avoid detection. So I wasn't terrified just yet. The obstetrician on duty was, like, our least favorite OB in our very small town. Very old-school, silver-haired guy with some problems in the bedside manner type area. (He couldn't find a heartbeat on our friends' baby at 8 weeks, so his first move was to give her pamphlets on miscarriage. That particular miscarriage is coming up on 2 years old.) Exactly the kind of doctor you can imagine telling an off-color joke to some golf buddies at the country club. The radiologist would be in tomorrow, he said. I spent the day with S, then went home to change and shower and get some sleep. I was still the picture of optimism at this point - probably a high leak, it'll get better. Wasn't amniotic fluid. All will be better. We're still having babies. Right?
Tune in tomorrow, when the entire medical staff pretty much says "wrong."
Thursday, March 13, 2008
How I Got Here, Part 1: "You Mean People Reproduce For Free?"
Well, how did I get here?
It all started in earnest about two years ago. My wife (let's call her S so I don't have to keep typing "my wife" over and over again) and I are in two different doctoral programs at the same university. She's a couple of years behind me, and in late 2005, we'd finally gotten to a place in our lives (financially, emotionally, and otherwise) where we could actually consider having children. Our thought was, of course, that we would just make with the unprotected sexing and a week or two later, voilá! Baby! Oh, for those days back again, when we were young and naive with the stars in our eyes.
So a few months of this approach wasn't really working, and we made an appointment with a reproductive endocrinologist. Over the course of multiple procedures, we determine that S has a clotting disorder, polycystic ovaries (well, that we knew about), mild endometriosis, and a cervix positioned at about 9 o'clock. So even if there weren't all those other things, my sperm would have to be capable of making a 90º turn to get where they need to go. Which isn't happening, because sperm analysis suggests that my swimmers are wandering around like they've been given wedgies and had their shirts pulled over their eyes. Basically, our chances of getting pregnant the old-fashioned way are damn near nil. So what do we do?
What we did, starting about two years ago, was begin a battery of vitamins for me to improve the quality of my sperm (we're talking multivitamin plus extra C, extra B-complex, selenium, zinc, folic acid, and Clomid to address a testosterone deficiency). For S, there were vitamins, baby aspirin, subcutaneous injections of heparin, and medications for the polycystic ovaries and clotting disorder.
And that was just for everyday use. When it got to be that special time, that certain time of the evening, when the lights are down low, Barry White's playing on the stereo, and we look at each other in that way...
...oh, who are we fucking kidding. Babymaking meant giving S an intramuscular injection of HCG in her butt to trigger ovulation (giving "tapping that ass" a whole new meaning), then getting up at some unholy hour the next day to go to the RE's office so I could go into a tastefully lit private room and do what all men do into a little plastic cup (with a disturbingly rough edge), and give it to a nice lady in the lab. Then we'd leave for a little while, grab some breakfast, and come back so S could climb up into a stirrup chair and have a little date with a speculum and a catheter. 15 minutes later, we're off to begin another cycle of waiting, peeing on sticks, fretting, hoping, and trying not to hope all at the same time.
At first, it all seemed really weird. I understand why people object to calling it "natural" conception if it's just sex, but with the visits and the doctors and the pills and the needles and the catheters and everything, it does seem about as unnatural as it gets. After the first two or three, it started to seem commonplace.
By the time we were on cycles 7 and 8, it was downright routine. We had sharps containers in the bathroom, boxes and boxes of alcohol prep pads. I bought one of those days-of-the-week pill organizers to keep on my nightstand. Every now and then, I'd look at our stocks of medical supplies, and wonder what we'd become that this was normal. But the alternative was no children.
We ended up doing 9 IUI cycles, all told. Three of those resulted in chemical pregnancies, and we were starting to lose hope. IVF wasn't really a useful option for us, because our problem wasn't getting pregnant. It was staying pregnant. So we started buying books on adoption. Neither one of us said anything out loud, but it wasn't looking good. However, we still had enough drugs (HCG and Lovenox, the fancy blood thinner) to do one last cycle. Hell, maybe 9th time would be the charm, right?
Well, it turns out it was. We got a positive pregnancy test, and another, and another. S went in for the blood test, and her beta value was doubling, and doubling well. We held our breath. S felt different this time - she started getting queasy. It was morning sickness, and although we weren't going to say anything to anyone else, we started to get excited. Well, S did. I'm a defensive pessimist. I wasn't going to let myself get excited until we got close to a trimester. We both knew people who'd lost children before the first trimester, and didn't want to get ourselves and everyone else excited for nothing. Still, S remained pregnant, and the queasiness bloomed into full-on constant nausea and puking. It sucked, but we figured it meant things were going well.
I can still remember the first ultrasound. Our RE pointing out two gestational sacs. He said "there's two of them in there." We were having twins. After all of this time, we were having twins. I was in shock, but not exactly excited. Not yet.
I remember when I did get excited. It was when we went to see a perinatologist, to do the early screening and nuchal translucency scan. I heard their heartbeats for the first time, and saw their little limb stubs moving around, kicking, developing backs arching and flexing. Two little pre-humans, working hard at growing. My heart skipped a beat. It was real. It was going to happen. We were going to be parents. We'd brought life into the world. The miracle of life - well, life and a fuckload of medical technology.
There was some drama around the results of the screening - we had an RE, a perinatologist, and a local obstetrician, and the lines of communication sometimes sucked a lot. All I remember was the OB saying was "yadda yadda 1 in 8 chance of chromosomal abnormality on Baby B" and we flipped right the hell out. What did he mean? Down's? Trisomie 18? 21? One of those things the baby won't survive? WHAT? Only notice we got from the peri was "we want to make an appointment with you next week", and S was all "fuck that, we're going in tomorrow." After a phone consult, we find out that we have an 11% chance of one of them having Down's. That was our worst-case scenario.
I deal with data a lot - percentages reassure me. S has worked with children with developmental delays - we both have some idea of what's involved with Down's. We feel like we can live with these numbers, and we make an appointment to do the amniocentesis. We find out that we have two chromosomally normal boys. It's starting to become real at this point. It sinks in. We're having boys. We start picking out names, and we tell friends and family and people in our programs. We're out of the closet, and people are delighted for us.
Next time: Worst Christmas Ever.
It all started in earnest about two years ago. My wife (let's call her S so I don't have to keep typing "my wife" over and over again) and I are in two different doctoral programs at the same university. She's a couple of years behind me, and in late 2005, we'd finally gotten to a place in our lives (financially, emotionally, and otherwise) where we could actually consider having children. Our thought was, of course, that we would just make with the unprotected sexing and a week or two later, voilá! Baby! Oh, for those days back again, when we were young and naive with the stars in our eyes.
So a few months of this approach wasn't really working, and we made an appointment with a reproductive endocrinologist. Over the course of multiple procedures, we determine that S has a clotting disorder, polycystic ovaries (well, that we knew about), mild endometriosis, and a cervix positioned at about 9 o'clock. So even if there weren't all those other things, my sperm would have to be capable of making a 90º turn to get where they need to go. Which isn't happening, because sperm analysis suggests that my swimmers are wandering around like they've been given wedgies and had their shirts pulled over their eyes. Basically, our chances of getting pregnant the old-fashioned way are damn near nil. So what do we do?
What we did, starting about two years ago, was begin a battery of vitamins for me to improve the quality of my sperm (we're talking multivitamin plus extra C, extra B-complex, selenium, zinc, folic acid, and Clomid to address a testosterone deficiency). For S, there were vitamins, baby aspirin, subcutaneous injections of heparin, and medications for the polycystic ovaries and clotting disorder.
And that was just for everyday use. When it got to be that special time, that certain time of the evening, when the lights are down low, Barry White's playing on the stereo, and we look at each other in that way...
...oh, who are we fucking kidding. Babymaking meant giving S an intramuscular injection of HCG in her butt to trigger ovulation (giving "tapping that ass" a whole new meaning), then getting up at some unholy hour the next day to go to the RE's office so I could go into a tastefully lit private room and do what all men do into a little plastic cup (with a disturbingly rough edge), and give it to a nice lady in the lab. Then we'd leave for a little while, grab some breakfast, and come back so S could climb up into a stirrup chair and have a little date with a speculum and a catheter. 15 minutes later, we're off to begin another cycle of waiting, peeing on sticks, fretting, hoping, and trying not to hope all at the same time.
At first, it all seemed really weird. I understand why people object to calling it "natural" conception if it's just sex, but with the visits and the doctors and the pills and the needles and the catheters and everything, it does seem about as unnatural as it gets. After the first two or three, it started to seem commonplace.
By the time we were on cycles 7 and 8, it was downright routine. We had sharps containers in the bathroom, boxes and boxes of alcohol prep pads. I bought one of those days-of-the-week pill organizers to keep on my nightstand. Every now and then, I'd look at our stocks of medical supplies, and wonder what we'd become that this was normal. But the alternative was no children.
We ended up doing 9 IUI cycles, all told. Three of those resulted in chemical pregnancies, and we were starting to lose hope. IVF wasn't really a useful option for us, because our problem wasn't getting pregnant. It was staying pregnant. So we started buying books on adoption. Neither one of us said anything out loud, but it wasn't looking good. However, we still had enough drugs (HCG and Lovenox, the fancy blood thinner) to do one last cycle. Hell, maybe 9th time would be the charm, right?
Well, it turns out it was. We got a positive pregnancy test, and another, and another. S went in for the blood test, and her beta value was doubling, and doubling well. We held our breath. S felt different this time - she started getting queasy. It was morning sickness, and although we weren't going to say anything to anyone else, we started to get excited. Well, S did. I'm a defensive pessimist. I wasn't going to let myself get excited until we got close to a trimester. We both knew people who'd lost children before the first trimester, and didn't want to get ourselves and everyone else excited for nothing. Still, S remained pregnant, and the queasiness bloomed into full-on constant nausea and puking. It sucked, but we figured it meant things were going well.
I can still remember the first ultrasound. Our RE pointing out two gestational sacs. He said "there's two of them in there." We were having twins. After all of this time, we were having twins. I was in shock, but not exactly excited. Not yet.
I remember when I did get excited. It was when we went to see a perinatologist, to do the early screening and nuchal translucency scan. I heard their heartbeats for the first time, and saw their little limb stubs moving around, kicking, developing backs arching and flexing. Two little pre-humans, working hard at growing. My heart skipped a beat. It was real. It was going to happen. We were going to be parents. We'd brought life into the world. The miracle of life - well, life and a fuckload of medical technology.
There was some drama around the results of the screening - we had an RE, a perinatologist, and a local obstetrician, and the lines of communication sometimes sucked a lot. All I remember was the OB saying was "yadda yadda 1 in 8 chance of chromosomal abnormality on Baby B" and we flipped right the hell out. What did he mean? Down's? Trisomie 18? 21? One of those things the baby won't survive? WHAT? Only notice we got from the peri was "we want to make an appointment with you next week", and S was all "fuck that, we're going in tomorrow." After a phone consult, we find out that we have an 11% chance of one of them having Down's. That was our worst-case scenario.
I deal with data a lot - percentages reassure me. S has worked with children with developmental delays - we both have some idea of what's involved with Down's. We feel like we can live with these numbers, and we make an appointment to do the amniocentesis. We find out that we have two chromosomally normal boys. It's starting to become real at this point. It sinks in. We're having boys. We start picking out names, and we tell friends and family and people in our programs. We're out of the closet, and people are delighted for us.
Next time: Worst Christmas Ever.
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