BrooklynGirl

The Whimper

For the last little while, I've been fighting the urge to pee on a stick to see the double line--even though I know it's just an accident of chemistry--because I knew it would be there. A reminder of some future possibility, if not one for now. That not now-ness kept me from doing it because it would seem a little too maudlin, too mawkish, too weird.

Today, though, the line wouldn't be there. My beta's under 5. I'm officially not even a little pregnant any more.

And while fear of mawkishness may prevent me from doing some things, it doesn't prevent me from repeating the lines of a poem I learned in high school that seems strangely appropriate today:

Between the conception
And the creation
Between the emotion
And the response
Falls the Shadow

......................

This is the way the world ends
This is the way the world ends
This is the way the world ends
Not with a bang but a whimper.

--T.S. Eliot, "The Hollow Men"

Perfectly Normal

I was nervous about calling the RE yesterday to talk about the bleeding. I was afraid of hearing him say something like “You’re still bleeding? Get yourself to an ER stat!” or maybe worse “So, what do you want? A medal?”

What he actually said, somewhat anticlimactically, was that the bleeding was normal, and that it would probably continue until my hCG bottoms out, which he thought might be in the next week to ten days (not, God willing, Tertia’s eight weeks).

Having heard that, I was suddenly seized with embarrassment for having called. I mean his explanation seemed pretty self-evident in hindsight, and so I felt silly and alarmist. Not good feelings. I fell all over myself apologizing for bothering him and got off the phone as quickly as possible. Phew.

I have a hard time with doctors—they make me nervous. And not without cause—I’ve had some doozies. In the gynecological field alone:

• The doctor who scared me to death by diagnosing me high blood pressure and insisting that I go see a cardiologist AT ONCE if I lived long enough to make it to his office. [The cardiologist wasn’t sure why I was there and said that my BP was borderline high, but that it would probably come down if I stopped drinking the better part of a six pack of caffeinated Diet Coke each day which, not surprisingly, did the trick and has never been a problem since].

• The doctor who called to give me the results of an abnormal Pap smear and started out by saying “We don’t know if it’s cancer.” [It wasn’t.]

• The doctor I was seeing when I had my first miscarriage who, when I called her in a panic, said there was nothing she could do, but that I could go to the ER if I “really wanted” and then was not available for a follow-up appointment for 8 weeks and thought blood tests to confirm that my hCG was falling were unnecessary. Oh, and her office lost my medical records.

So, yeah, I have trust issues with doctors. And an overwhelming desire to be, as Pazel once described, the Good Patient. The one who doesn’t rock the boat or make unreasonable demands, and about whom the doctor does not think “Not her again,” when she shows up for an appointment. And yet....I know this shouldn't matter. I haven't gotten better medical care because I'm low maintenance. In fact, there are times I've probably gotten worse.

I need to work on this....ideally before my "what next" appointment on August 17th.

It's 3 PM--Do You Know Where Your Beta Is?

I've only ever been to one fertility clinic so I don't know how most clinics do things or even the best way to do things: I just know how my clinic does things. And here it is:

To get a beta, you go in with the regular monitoring patients in the morning. Since it's just a blood test, it's easy in/easy out--no pesky dildocams to worry about. In the afternoon, a physician's assistant or nurse calls with the test results, unless your betas have plateaued and they think you have an ectopic pregnancy--then the doctor calls you himself (and you panic as soon as you hear his voice).

Now in my personal opinion, they call with results uncannily early in the day, but after you've been waiting 2 weeks (or, say 2.5 years), the time between when you give your blood and they call with the results seems endless. The earliest call I've gotten was at 11:30 am (negative), another was at 12:45 (chemical pregnancy), another was at 2:15 (positive), another was at 2:30 (doubling positive), and still another was at 3:00 (ectopic). So, the conclusion I draw from this is you want a call by 2:30 at the latest. Nothing good can happen after 2:30.

Oh, and here's the other thing: you can leave a specific phone number for the clinic to call with your results. If you work during the day, you can have them call your office. If you're out and about, you can have them call your cell phone. If you're deeply neurotic and don't really want to talk to anyone about your results until you've had a chance to process them, thanks very much, you have them leave a message on your home phone which you can pick up at your leisure--if by leisure you mean calling to check your messages every 5 minutes or so beginning at 11:30. If something unexpected(ly bad) is going on, the clinic somehow manages to find you wherever you are--at the office, on the cell, hiding under your bed.

If you're on your 8th beta day, anxiously waiting to hear that your numbers are continuing to fall, you might be exceptionally jumpy. You give your blood at the appointed hour and then start checking in with your answering machine at around 11. When there's no call by 1:00, you go out to lunch with some friends and turn your cell phone off. When you get back to work at 2:00, you check your machine, your office voice mail, and your cell phone, and finding no messages, you start to bite your nails.

You stop calling your home machine worried that the clinic can't get through because you're tying up the line. You busy yourself with tasks to try to distract yourelf from the passing minutes. You talk to your colleague about the intricacies of his gluten-free diet. You talk to another colleague about the relative merits of the AP Stylebook over The Chicago Manual of Style. You avoid noticing that it's 2:30, 2:45, 3:00.

You wonder what's the worst that could possibly happen: did your level not drop enough? Did it stay the same? Did it go up? You and your Infoholic Witch research what those options might mean. You worry that they'll want to give you more methotrexate and that you're going to have to tell your doctor that you started drinking again the moment your liver function test came back normal.

When the phone at your desk rings at 3:10, make yourself answer it. Sigh audibly when you hear a physician's assistant's voice instead of your doctor's. Think that it can't be that bad if your doctor's not calling himself. When she tells you the level is 130, ask what that means, why it isn't falling as quickly as it was before. Don't believe her when she says that it's okay as long as it's falling. Hang up the phone.

Instant message your husband, "When is this going to be over?" Realize you're crying and aren't sure exactly why. Splash some water on your face. Wish you were more like Jo. Update your blog.

What Passes for Good News

Yesterday's beta was down--way down--to 167. So I took the first deep breath I've taken in awhile and started to believe that I might actually be waking up from this nightmare.

I've been thinking a lot about what's next because, well, that's what we infertile folks do. My doctor mentioned wanting to repeat an HSG to check for tubal damage, which seems prudent. Before the subject of ectopic reared its ugly head, he also talked about testing for clotting issues so I'll raise that with him again.

And beyond that, I don't know. We'd been planning to do our first IVF this month to take advantage of the free time and low stress afforded by my summer vacation, but now that's moot. It's unlikely that I'll be able to cycle before I start student teaching on September 7. So I find myself thinking about IUI again, since it's easier to schedule around the rest of my life and at least partly covered by insurance. Of course, whether or not that's a realistic depends on the relative condition of my tubes, which may have been well and truly fucked from this whole experience.

Alas.

So Far, So Good

My hCG has fallen to 513. So, well, phew. The methotrexate is working. I go back on Sunday--and the trip will include a stop at Doughnut Plant to mitigate the awful early morningness of it all.

If my love of all things sweet and tasty has returned, that's surely a sign of recovery, right?

Ectopic, They Presume

My hCG came back at 651 and given that week-long plateau, the assumption is an ectopic pregnancy. I got my methotrexate this afternoon. We've rescheduled my husband's birthday dinner.

I'm going to go out on a limb and say it can't get much worse, but I'm not even sure I believe it.

Thanks so much for everyone's comments and emails--it's really meant a lot to me.

Sunday Bloody Sunday

I was awoken by uterus-gripping cramps and the accompanying blood-fest at around 4:30 Sunday morning. It was something of a relief to finally have my body do something that felt so definitive.

Still, I reported for my ultrasound this morning, and all things looked relatively good--or as good as they can mid-miscarriage. My uterine lining is sloughing off beautifully, thanks very much.

There's still no official word on whether this was a uterine pregnancy though. If my hCG levels come back lower this afternoon, then we'll assume it was and just monitor them until they hit zero. If, on the other hand, my levels do not fall significantly, I get an injection of methotrexate. And since I know how harrowing this was for Julie, I'm really excited about that.

As a final reminder that nothing is ever easy, after my uncooperative veins were prodded by not one but two phlebotomists this morning, somehow those hard-won vials of my blood were accidentally discarded, and I had to return to the clinic a second time for more blood letting. Everyone was very apologetic so I tried to be a good sport about it. It wouldn't be so bad if I weren't already planning a third visit later this afternoon for a RhoGAM injection. Good times, good times.

The Afternoon Update

So, Tuesday's hCG was 658. Today's is 655. So we're making no kind of progress. Next step: ultrasound on Monday to try to confirm that it's not ectopic. And did I mention that Monday is my husband's birthday? Um, yeah. Great.

A Poke Without Promise

Now, I know I always complain about going to the clinic when I'm cycling. I hate the getting up early, the long slog on the subway, and the uncooperative veins, but somewhere in the midst of it there's a little dash of hope--even if my E2 level is rising too slowly or there aren't very many follicles. There's still a reason to think to myself that maybe, just maybe, this will work whether or not I admit it.

And when I diligently go for my beta--even when the HPT has been negative--I still wonder if there won't be a miracle. Again, maybe.

But today, when I made the trip, there was no maybe. The best that I could hope for was a cooperatively falling beta, and there's not much hope in that. It's hard not to take the crowded train, the aggressively bad-smelling panhandler, and the phlebotomist who needed to poke my arms three times before she found a willing vein personally. I mean really.

When I dared to think that this might all end well, it never occured to me to believe that I had finally struck a deal with God, that S/He had looked down at me and said, "Okay, you deserve this" because, well, I guess I don't believe in that kind of God.

But somehow, it's easier to believe in the involvement of a Divine Hand for the bad stuff. What did I do to deserve this? Was it the beer I drank after I got my "period" when I thought I couldn't possibly be pregnant? Was it the day I didn't give up my seat on the subway to a pregnant woman because I was too bitter? Was it the time I saw the squealing children with their mother ahead of me in line in the grocery store and thought "Thank God that's not me?"

I wish I could get beyond the "why me-ness" of all this as classier ladies than I have, but I can't. There are lots of wonderful people out there in pain. Here. And here. And here. To name but a few. They don't deserve it. I know that. Why is it harder to know that about myself?

Definitely Not

My hCG level was only 600. It should have been over 3000. The question remains, however, whether my levels are slowly rising or falling, and the answer to that question will determine what we do next. He wasn't willing to rule out ectopic--he said the sac was unclear enough that it could be a blood clot--so that's a little scary.

This is my third loss if you count last month's chemical, which he does. And three is that fabled number where things get serious. As if they didn't feel serious enough already.

I go back for more bloodwork on Friday.