Monday, May 19, 2014

Hello and Goodbye

It's been a while since I last blogged. It's been a roller coaster of emotions. Trigger warning: miscarriage, D&C.

On January 30, the two remaining embryos my IP's had frozen were thawed and transferred to my uterus. It was an exciting day.

4 1/2 days later (4.5dp5dt), I took a home pregnancy test. There was a VERY faint line. 12 hours later, the line was darker and no squinting was necessary. I emailed IM to tell her the good news. She was thrilled. Over the next few days, my tests continued to get darker and I got more and more antsy for my beta (blood test that measures the exact level of hCG that's present in (of course) your blood).

6.5dp5dt BFP (Test: First Response Early Results)

On February 10, I went to the lab and had my blood drawn. The results were good, my beta was 415! A week later, I went for a repeat beta (they do two to make sure your hCG level is rising properly indicating a viable pregnancy) and the result was 5906. Again, a very good result.

On February 27, at 6w5d pregnant,I went for an ultrasound at the clinic here in town that was being used as my monitoring clinic (since my doctor is a good ways away, most of my appointments for ultrasounds are done at this clinic and the doctor there sends the reports/results to my doctor).

Ultrasound pictures from 6w5d. Fraternal twins!

We were able to see that both embryos had stuck around and were able to see and hear both of their heartbeats. When the picture came up on the screen, I think I said something brilliant like "Is that two? So that means it's twins, right?". It was amazing and incredible and super cool. In all honesty, it also felt a bit overwhelming at first. Even though I had known that transferring two embryos meant chances were good I'd carry twins, and even though I'd had a gut feeling since early on in the home pregnancy tests that it was twins, it was still this slap of reality that "HOLY CRAP! There's TWO in there!!!". I think I actually told a friend "I know how to be pregnant. I'm good at being pregnant. I have no clue how to be pregnant with twins.". I was scared, but also excited, and my IP's were over the moon. I was even more excited that evening when I found out that I only had to do one more shot of Delestrogen and would then only be taking progesterone via injection and via vaginal suppository.

On March 13, 8w5d pregnant, I went back to the monitoring clinic for another ultrasound. Both babies still looked good, were actually recognizable, and had great heartbeats. One twin was still measuring a few days behind the other, but everything looked picture perfect. I was told to go ahead and schedule an appointment with my OB  for 3-4 weeks later.

Ultrasound pictures from 8w5d. 

On March 28, I had a blood test to measure my progesterone levels. My progesterone levels were sufficiently high, and I was far enough along in pregnancy, that I was able to stop doing the injections. I was to continue the vaginal suppositories for a few more days and take my final suppository the evening of March 31. March 31 was also my first OB appointment, so it was a Big Day that I was counting down to.

March 31 rolled around. It was a Monday, and the first day of Spring Break. I was 11w2d pregnant. I was excited to see my OB (she was also the one who was present when I delivered my youngest son and she's an absolute doll). I was excited to get to see the twins and have more ultrasound pictures and video to send to my IP's (Besides emailing them u/s pictures, I'd been able to use my phone to record parts of the u/s and send it to them, so they could see movement and see and hear the heartbeats). Since my OB is herself the mother of twins, I was looking forwards to her input on carrying and delivering twins. I also wanted to find out whether she usually sees twins born before 40 weeks, what the latest is that she'd permit me to travel for an uncomplicated twin pregnancy, and other such questions.

I went back to the room. My OB came in the room, hugged me, and we exchanged greetings. I told her, quite excitedly, the story, and she asked a few questions to make sure the details in my chart were correct. She then had me lie down on the exam table for a quick check of my uterus size. Then, it was time for The Ultrasound.

In the space of seconds, the world came crashing down around me. She asked if I knew which twin had been measuring smaller and said that the first one she was looking at didn't have a heartbeat and was behind in . I wasn't totally shocked since one twin had measured a few days behind from the first ultrasound and I had known this was a possibility. She moved the u/s wand around to look at the other twin and... nothing. Two babies in two sacs, no heartbeat, no movement. Nada. They were just floating there, motionless; it was as though time had stopped inside my womb.

Upon measurement, the twins measured at 9w2d and 9w5d, indicating that they had died about a week after my last ultrasound at the monitoring clinic, they had been gone approximately 2 weeks by the time of this OB appointment. I don't have a very clear memory of everything the doctor said, aside from "I'm so sorry. I wasn't expecting this at all". She told me that she'd do another u/s, or be happy to give me a referral to a different OB or back to the monitoring clinic if we wanted someone different to take a look. She talked with me about the options moving forwards (wait for my body to miscarry on it's own or various methods to manage it medically), genetic testing, etc. I told her I'd call her back as soon as I'd had a chance to talk to my IP's, the fertility doctor, and the agency to see what needed to happen.

I headed home with my husband driving (he'd been in the waiting room with our kids). I dropped them off at home and headed out: partly to get some time to myself to think and process, partly to get a cell signal so I could make some calls. I remember it was raining. I had a phone call with a wonderful young woman from my church; at the end of the phone call (which left me both in tears and feeling a slight measure of comfort), a huge and beautiful rainbow appeared. I remember thinking that both the rain/dreary weather and the rainbow were appropriate.

The decision was rather quickly made to have my OB do another u/s to confirm that we had a missed miscarriage on our hands and, barring a literal divine miracle, schedule a D&C. They wanted a D&C so they could be sure of having all the tissue collected to send for genetic testing to make sure that there weren't any genetic abnormalities at fault. I wanted to just get it over with and to NOT have to remember the process of miscarrying. It was also convenient since I was on Spring Break. I wasn't particularly keen on the idea of waiting it out, going around uncertain when it would happen, worrying about miscarrying in the middle of a math exam, speech in class, at church, or out to dinner with my family. I just wanted it done and over with. I thought multiple times that this had to be some type of horrible April Fool's Joke. It wasn't.

On April 2, I went back to the OB for the follow-up ultrasound. I had been told earlier that the doctor had a patient in labor so there was potential that my appointment could wind up rescheduled if a delivery was taking a while. I got to the office and sat there in the waiting room. I had brought my iPad fully charged with a couple of new books loaded on my Kindle app. I always expect to wait at an OB/GYN's office because babies, like honey badgers, just don't give a flip. During the course of my wait, I was treated to  quite a performance by another patient and her mother (both fully grown "adult" women), who stormed out yelling about having to wait for the doctor and how dare they, and slamming the doors so hard the walls rattled (literally. The walls rattled. That's not an exaggeration). The other patient in the waiting room and I exchanged The Look, raised eyebrows and everything, and discussed how ridiculous it is to be upset at having to wait for a doctor who delivers babies, and how much we like that an OB/GYN who takes her time with her patients, including in office visits, rather than rushing you and ignoring questions. I do remember thinking "Those women should STFU. For all they know, the doctor could be running behind because a patient ended up with an unexpected missed miscarriage showing up on the ultrasound".

Eventually, it was my turn. As I had expected, there had been no Heavenly AED, no angel Gabriel who did fetal CPR, no miraculous divine intervention. The doctor scheduled me to go to the hospital for a D&C on April 4. I had wanted to go in the next morning but she explained that it would be better for me to come to her office the next morning and have a laminaria inserted into my cervix, to allow me to dilate more slowly over time, thus lessening the risk of damage to my cervix that could occur by just forcing it to dilate suddenly.

April 4 came. I took a Valium the night before to help me sleep and to have me a little less high strung the next morning. It also needed to be the night before because the hospital didn't want me to eat or drink anything after midnight since I would be going under general anesthesia. Anyways. I had to be at the hospital by 6:30 to get pre-op stuff done. I arrived, filled out the last of the paperwork (most of it had been done the day before with admissions), and got dressed in the lovely hospital gown, socks, hair net hat thingy, and whatever else they had me put on. There were those little wrap thingies that go on your calves to hook up to a machine that massages you, I think, to keep circulation going or whatever. I was eventually whelled into the pre-op area, where I read my chart out of boredom and tried not to cry. I was given a dose of... erm... some IV drug that was to help me relax and to get me started on the path of anesthesia. Shortly thereafter, I was wheeled into the OR where I was greeted by the anesthesiologist and my OB. My last clear memory was of the doctor telling me hello. The anesthesiologist was very good at his job because I don't even remember getting sleepy. I think I remember being asked to breathe something through a mask but t's very hazy and I can't swear that it actually happened vs. being a figment of my imagination.

I closed my eyes to blink.

I opened my eyes and I was lying on my back, staring groggily up at the ceiling, with someone saying "There you are." and the OB telling me "It's all over, it went fine.". My throat stung a little from the tube that had been in it while I was under anesthesia. I immediately started to cry and someone got me another dose of medication to help me calm down. I was wheeled back to recovery, and then wheeled back to my room. Eventually, I was able to go to the bathroom to get dressed. I sat down on the toilet, passed a very large clot, freaked out, and pulled the emergency call button thinking I had just passed some retained placenta or something. Nope, clots are normal. Oops.

I was discharged. I declined any pain medication, having been told I would experience "cramps". My friend took me home. When I left that morning, I had set up the couch downstairs with blankets, pillows, etc. so that I could just go to sleep there and not have to worry about navigating the stairs. After I got home, I decided it had been a very smart idea. About this time, I decided that "cramps" was a piss-poor description and informed the cat that I was pretty sure my uterus was trying to claw it's way out of my body through my belly button. I took 800mg of Motrin and curled up, moaning and groaning and pretty much cursing Eve for eating that damn apple. The cats were very attentive to me all day and were obliging enough to curl up against my abdomen and purr, which actually did help my cramps (vibrating heating pads are the bomb for cramps, btw). Another friend brought supper by that evening.

And that's the story of my first surrogate pregnancy.

It was one of the most emotionally difficult things I've ever gone through. Just recounting the events is difficult, even without getting too much into the emotions and recovery. It seemed most appropriate that the evening I found out the twins were gone and the next day were rainy and dismal and dreary. It was as though heaven and nature wept with me.

I can't really describe adequately what it felt like, to lose someone else's babies. To lose something that is in me but not mine, but entrusted to my care. Grief, anguish, anger, confusion, guilt (lots of guilt, even though I knew it wasn't my fault), sorrow... so much pain, and being upset for my IP's, grieving for and with them and for their loss. My heart breaks for them, for everything that they've been through, and now this, just when it seemed like everything was perfect and it was meant to be. I have felt so much pain, but it's not a pain that I can describe, or that anyone can understand unless they have themselves been in that situation.

I'm doing a lot better now, and my IP's and I are moving forwards to try again. I'm going down to LA this week for a hysteroscopy to make sure my uterine lining is still in good shape. I'm hoping we can start cycling again soon and transfer again before too much longer. The next round will be a fresh transfer since the twins were the last two embryos my IP's had frozen.

I had planned to focus this post more on emotional aspects of what it's been like in the emotional aftermath, but I think I needed to just write down What Happened, to process the timeline. I may write more later about the topic, I may not. I don't know.

Dearest little twins,
You were so loved by many people.
You were wanted more than words could truly describe. 
If there were anything I could do to bring you back, I would.
I would move heaven and earth if it meant I could deliver you safely into your parents arms, full of life.
But I am not God, and I can not.
So all that I can do is to carry your memories with me through life, 
to honor your memories as best I can.
I promise that you will never be forgotten and will always be loved.
You were in our lives for such a short time, but you made an impact.
I will speak only for myself and say that you changed my life.
Like little butterflies, you came and went, fragile but beautiful, not there for long, but most certainly There.
For you I sing:

"Said goodbye, turned around
And you were gone, gone, gone
Faded into the setting sun,
Slipped away
But I won’t cry
Cause I know I’ll never be lonely
For you are the stars to me,
You are the light I follow

I will see you again, whoa
This is not where it ends
I will carry you with me, oh
'Til I see you again"
-See You Again, by Carrie Underwood