Essay by Cara Holman
My miscarriage happened so long ago, that I rarely think about it consciously anymore. But when my gynecologist recently informed me that she needed to perform a uterine biopsy on me “just to be on the safe side”, memories and feelings that I thought I had safely buried, came flooding back to me.
It took me back to the time when I had a lively three-year-old at home, and was expecting my second child. I had just passed the second trimester mark, and now that the morning sickness was starting to subside, I was basking in the glow of my pregnancy. My life seemed picture perfect- I was happily married, had an active, healthy young son, and lived in the house of my dreams high up on a hill in Seattle, overlooking the lights of downtown at night. On a really clear day, you could even see Mt. Ranier through the window of our breakfast nook.
Motherhood was everything I had hoped it would be, and then some, in spite of the occasional temper tantrums- my son’s that is, not mine. I could hardly wait for the day when I would hold my second child in my arms, a day that I believed would cement us as a family, rather than merely a couple with a young child. I was one of the last of my circle of friends to get pregnant with a second child, believing that a three to four year spacing between children would be ideal. Jeff would be almost exactly three and a half years old when his new sibling was born in the spring, and I envisioned long days in the park nursing my newborn while I watched Jeff and his friends running around on the playground.
I woke that morning with a feeling of foreboding, but it had nothing to do with my pregnancy, or me either, for that matter. Today was the day my husband was scheduled to have arthroscopic knee surgery. Although his surgeon had assured us that it was a very straightforward procedure, with every expectation of success, still it weighed heavily on my mind as I slowly dressed for the day. I had made arrangements to drop Jeff off at a friend’s house, thinking that a hospital was no place for a restless young child.
“Don’t worry about what time you’re done,” Diane says cheerfully. “I’ll take the boys to the playground this morning so they can release a little energy, then I’ll give them lunch and they can play in our playroom or watch a video. He’ll be fine,” she assures me, nodding her head at Jeff who is already running around the house with Tyler.
As Tom and I head for the hospital, I notice the fall color by the side of the road, and relax just a bit. The muted October sunlight raises my spirits and I can’t help but think what a shame it is that we aren’t taking advantage of this nice weather. We should be heading out to watch the boats in the ship canal, or spending the day at the zoo instead of the hospital. Still, I have every expectation that in a few short weeks, things will be completely back to normal again, and maybe the nice weather will hold out for just a bit longer.
While we wait nervously for Tom to be wheeled into surgery, I suddenly remember that I have a prenatal visit scheduled for that morning, and in the flurry of activity with the pre-op and all, I had forgotten to cancel it. “Go ahead and keep your appointment,” he tells me. “I’ll be in surgery for several hours and it won’t take you long. Forty-five minutes at the outside.” He was right. Erica’s house is just up the road, and I could be there and back in almost less than the amount of time it takes to talk about it. We had thrilled at the sound of the first fetal heartbeat at the last visit, so this would just be a routine check, nothing to get too excited about.
I pause on the front steps of Erica’s house to once again take in the beauty of the day. There are some chrysanthemums blooming in her garden, in all shades of yellow and orange, and I am admiring them when Erica comes to the door. “Where’s Jeff?” is her first question, as she shows me into the upstairs room she uses to see her patients. While most other nurse-midwifes practice out of traditional offices, Erica prefers to see patients in her own house, and I fully appreciate the homey, non-antiseptic atmosphere. I look over at the toy bin in the corner, and smile as I remember how delighted Jeff was to discover it on our last visit.
I explain that I have left Jeff with a friend while my Tom has knee surgery. “I’m kind of in a hurry to get back to the hospital,” I conclude. “Anyway, I’ve been feeling fine. Great, in fact, now that the morning sickness is over. I guess it’s still too early to feel the baby moving?”
Erica does a quick calculation in her head. “Let’s see, you’re 15, no almost 16 weeks along. You could feel the baby move at any time now.” She works briskly and efficiently, all the while keeping up a conversation. It is when she pauses mid-sentence to listen for the fetal heart tones, that I see an expression of concern cross her face, and then just as quickly disappear.
“You know,” she says, in a carefully measured voice, “I’m not picking up the fetal heartbeat.” She glances at her clock on the wall. “I don’t want to take up any more of your time today. I know you’re in a hurry to get back to the hospital. I’ve been having a little bit of trouble with my equipment lately. Why don’t you just come back on Thursday and we’ll check again. I’m sure everything is okay,” she hastens to assure me.
I suddenly get a feeling of déjà vu. Everyone seems to be assuring me things will be just fine: first my husband’s surgeon, then Diane and now Erica. Still, I’m not overly concerned at this point. If Erica isn’t worried, why should I be?
I hardly give the matter another thought in the ensuing days, something highly unusual for a chronic worrier like me, to be sure, but my mind is on my husband’s recovery, and after all, hadn’t Erica assured me everything would be okay? Between taking care of Tom, and keeping Jeff busy, the next three days pass rapidly, until I am once again back at Erica’s to listen for the fetal heart tones.
It is when she still can’t pick them up, for the second time now, that the first inklings of fear begin to seep into my mind. With Tom well on his way to recovery, I begin to focus again on my pregnancy. Why isn’t Erica picking up the fetal heart tones? Is it still too early? No, that doesn’t make sense. We heard them clearly at my twelve week visit. Was her equipment really on the fritz last time, or was that just an excuse she made to make me feel better?
As I look up at her, I see at once that this time she is concerned, though she still keeps her air of brisk efficiency about her. “I think we should schedule you for an ultrasound this afternoon,” she says, “just to be on the safe side.” I notice she is not so quick to reassure me everything will be fine this time.
She steps out of the room to make the arrangements. I take a deep breath and try not to focus on the fear that is slowly threatening to engulf me. What possible logical explanation is there for her not being able to hear the fetal heartbeat this time around? If it is not her equipment that is at fault… But here my mind clearly draws a line. I will not think about the other possibility. What could possibly have gone wrong? Wouldn’t I have known it if there was a problem with my pregnancy?
An hour later, I am in a darkened room, while a young woman whose nametag reads “Jessie” runs a probe over my abdomen. I am not really in any discomfort, except perhaps a little from having a full bladder. As this is my first ultrasound ever, never having had the occasion to need one during my first pregnancy, I don’t really know what to expect. The grainy picture on the screen is quite frankly a disappointment. I have no idea what I’m seeing. I try squinting to see if I can almost make out the baby’s features, and I think I can see a head and body emerge from the black and white image. However, try as I might, I can’t seem to detect any movement.
I glance over at Jessie again. Her eyes are glued to the computer screen as she continues to move the probe around. “Can you see the baby moving?” I ask her hopefully.
“Well,” Jessie says, in the carefully measured tones that I have since learned to equate with bad news, “it’s difficult to say. The radiologist will read it this afternoon and call your doctor with the results.”
“Midwife,” I correct her. I try one more time. “If the heart was beating, would you be able to tell?”
Jessie’s face remains impassive. I notice she still studiously avoids eye contact with me. “The radiologist will read it,” she reiterates firmly, and chastened, I lapse into silence. Although it will be a full two more hours before Erica calls me at home with the news, in my heart I have already read the writing on the wall. I know not how, I know not why, but apparently my baby has died. I am only 31 years old. I have had one non-eventful full-term pregnancy. I have a healthy young son. I myself have always enjoyed good health, and now with no rhyme or reason, they tell me my baby has died.
I feel full of grief, heartbroken, bewildered and inconsolable. Why me? I keep asking myself. Why me? I quite honestly don’t understand. If the baby died, why didn’t I miscarry spontaneously? Why should I believe what they tell me? What if they’re wrong and there’s nothing wrong with the baby? My head is swirling with questions. It is all I can do to get through the rest of the day. Erica drives over and leaves me with some inspirational books about miscarriages and I try to make sense of them. I cry a lot, being careful not to do so in front of Jeff. Still, he senses something is wrong and he is very clingy and insecure that night, adding a layer of guilt on top of my grief.
I am scheduled for a pre-op the next day, and Tom accompanies me to the visit. Somehow, the irony of the situation strikes me. A week ago I was accompanying him to his surgery. Now it will be my turn. When we spoke our wedding vows a mere six years ago, who would have imagined that we would reach the “in sickness” part of “in sickness and in health” so soon? How can this be?
A very pregnant woman checks me in, chattering away about how she only has one more week of work left before she takes her maternity leave. It is her first child, she tells me, and she is very excited. I manage a weak smile. Here she is just bursting with life and vitality. She has a live baby kicking and turning inside of her, while my womb has become a tomb. A place of death. In a week or two, she will hold her baby in her arms. I never will. What went wrong?
As she checks my chart to see what lab work I am scheduled for, she breaks off suddenly, and a look of pity crosses her face. “I am so sorry,” she says in a low voice. “I had no idea what you were in for, and here I am chattering away about my baby…”
“You couldn’t have known,” I reassure her. Is everyone going to pity me now, I wonder. Be afraid to talk about babies in front of me? I am to find out later that the answer is yes, at least initially.
We finish with the financial office, the lab, the anesthesiologist, and now there only remains to meet with the surgeon, a Dr. Olson. He is a very young man and I feel almost sorry for him. Clearly he is in the awkward position of having to break bad news to a woman he has never laid eyes on before. Funny, I already seem to be in the pattern of trying to make others feel less uncomfortable, when shouldn’t they be comforting me?
Dr. Olson is talking to us in a calm voice, a tone I have since learned to be suspicious of. It seems that the calmness of a physician’s voice is in inverse proportion to the severity of the situation, and Dr. Olson is very calm. Too calm. He tells us he is sorry, that these things happen more often than one supposes, that there was nothing I did to cause it. In his way, he is trying to make me feel better I guess, but all I want to do right now is to curl up in a little ball and cry my pain to the universe.
He is still talking, and I struggle to keep up with him. He is saying something about some grape-like structures the radiologist saw in my uterus. I note that Dr. Olson is speaking very earnestly now, and searching my face as if there is something terribly important that I am to comprehend. Why would I care about these grape clusters in my uterus and why is he telling me this now? Does he think making small talk will cheer me up? If so, it’s not working. His words continue to wash over me, not fully penetrating until a single word lurches out at me. Chemotherapy.
I am stunned. I look around the room, searching for clues. Is he talking to me? Wrong patient, I want to tell him, but my lips won’t form the words. I’m the one whose baby died, remember? You’re confusing me with some cancer patient. But he goes on speaking. Apparently I have something called a molar pregnancy. A partial mole, he amends, since at one point there was a viable fetus. Well, maybe not so viable after all. He continues to tell me that the fetus had a condition which made it “incompatible with life”. There was nothing I could have done to save my pregnancy. Is this consolation? I hardly know.
What I do know, or least come to understand as I relive his words in my mind that weekend, awaiting Monday’s surgery, is that not only has my baby died, but my levels of hCG, the pregnancy hormone, are seriously elevated and this is considered a pre-cancerous condition. A week ago I was living in blissful ignorance, still believing I was carrying a healthy baby, when really all the while, some pre-cancerous cells were multiplying inside of me, and my baby had already died.
Cancer! Okay, pre-cancer, but still! I fluctuate between disbelief and horror. Except for fiery car crashes, there is scarcely anything else in this world that brings the same level of dread and horror to my mind. Cancer! This all seems like a bad dream. I wildly consider doing nothing, but how could the doctors be wrong? They do this everyday for a living. Surely they know what they’re doing.
Monday I check into the hospital for a D & C, and go home hours later. It is a long journey to recovery. There is of course the physical healing, which in a funny kind of way is the least of my immediate problems. A week after my surgery, I am back on my feet and more or less my old self. The emotional recovery is much more difficult.
I beg my friends to tell all of our mutual acquaintances about my miscarriage, so I don’t have to repeat seeing the shock on everyone’s face when I inform them that I am no longer pregnant. I still encounter pity, and it is wearying. Everyone means well, though. I keep reminding myself of that. The cards and flowers and meals come pouring in. Almost like someone just died. Wait, I guess someone did just die, but it’s hard for me to know how to think about my miscarriage. Was it a baby? A fetus? The words “incompatible with life” come back many times to haunt me. Was it ever a baby? I finally decide yes.
I also decide not to ask what gender the fetus/baby was, and consequently, I never name it. It is never to become “he” or “she”. It will always remain “it”. It hurts less that way. And because inducing labor was considered too dangerous and I ended up having a D & C instead, I never laid eyes on my child. In fact, the only tangible proof I have that I was ever pregnant in the first place, besides the mounting hospital bills of course, is the ultrasound. I ask Erica if she can get me a copy of the ultrasound picture as a keepsake of sorts, and she obliges. So now, all I have left of the pregnancy is the grainy picture.
But I understand, even as I grieve for the loss of my baby and the loss of my dreams, that I have far greater immediate problems to deal with. I myself am not out of the woods, with the risk of cancer looming over me. I learn at my post-op that I will have to have my hCG blood levels monitored for a year. If they don’t decline, and eventually go down to zero, I will have to repeat the D & C. And if that is not successful in eradicating the residue of these “grape-like” structures, then we will talk about chemo. Dr. Olson hastens to assure me though, that even if this worst case scenario comes to pass, this type of pre-cancer (or would it be considered full-fledged cancer at that point?) is highly susceptible to chemotherapy and very curable. This is like a bad dream. I simply cannot believe that Dr. Olson is sitting here calmly discussing chemo with me as if it was an everyday occurrence.
It is amazing however, what the mind can get used to. As the next few weeks pass, my life begins to return to normal. In the first place, I have a demanding three-year-old to care for and a husband also recovering from recent surgery, and knowing I am needed helps ground me back in reality. The frequency of my hCG tests decreases, and I start to tolerate being poked constantly by a needle, without feeling like I need to pass out. The trick, I soon discover, is not to watch the needle go in or to look at the vials of blood after they are drawn.
The much harder part is the waiting, between when I have my blood drawn and when my results are available. The uncertainty is almost worse than receiving bad new. I try so hard to put it out of my mind, telling myself that worrying about it won’t make things any better, but worrying is not a rational emotion and I am only moderately successful in talking myself out of my fears. The day at last arrives, three months later, when my hCG level is almost zero, and I finally let myself believe that I will soon be able to put this pre-cancer business behind me.
Friends and family have been tremendously supportive, and people finally stop treating me with kid gloves, and begin talking about babies in front of me again. I watch four women I know from Jeff’s co-op preschool, and then my own sister, go on to deliver healthy babies. I am happy for them, I really am, although inside I still feel a twinge of pain, and yes, some jealousy when I see someone with their newborn.
I also finally allow myself to think about what I will do when my twelve months of hCG level monitoring are up, if my test results are still clean. Will I still try for another pregnancy? I think yes, but defer making the decision until I am actually faced with it. I am seeing an ob/gyn now. Erica has sadly informed me that since I am now considered “high-risk”, she can no longer provide my care. It is a label that I never asked for, and have a hard time dealing with. How can I be high-risk when all my life I’ve been healthy? Why did this have to happen to me? What did I do, or not do, to deserve it?
There are two things that cause me to re-evaluate my life and contribute to making me feel less sorry for myself, and aid in my healing. In the first place, I find out that I am not alone. It turns out that when others learn of my miscarriage, it makes it okay for them to share their own miscarriage stories with me. I am simply amazed to learn how many women I know have experienced miscarriages in the past, and yet I never had any idea. I can’t decide if this is due to the taboo about talking about death in general, or if it simply doesn’t come up in the course of everyday conversation.
In any event, it gives me a tremendous sense of relief to be able to share my feelings with other women who have gone through a similar experience, because by now, most of my friends have made it clear that they think it is time for me to move on, and they are tired of hearing about my miscarriage. In a way I can hardly blame them, but should there really be an arbitrary time limit for grief? Eventually, I do arrive at the point where I can talk conversationally about my miscarriage without my eyes welling up with tears, and the need to discuss it all the time diminishes.
But I said that there were two things that caused me to re-examine all my belief systems. The second is that the day my hCG level finally drops to zero, and I am cautiously optimistic for the future, no, make that joyous, I call my mother to share the good news. After congratulating me, Mom, it seems has news of her own to share, and not such good news at that, although she tells it so matter-of-factly that I am momentarily caught off guard. She has been diagnosed with a pituitary tumor and needs to undergo surgery. Brain surgery. Oh, Mom! I am absolute convinced that this is a death sentence for her, and the thought of losing my beloved mother is unbearable. My own problems pale in comparison to hers.
I am to learn that day that problems are only relative, and that no matter how bad things seem, they can always be worse. Mom’s situation is hands-down worse. But not hopeless. I also learn that where there’s life, there’s hope, and that while time may not exactly heal all wounds, it at least it softens them and makes them easier to bear. I discover that contained within us, humans have an almost limitless capacity for physical, emotional, and also spiritual healing. It is not an easy process though. It takes time and patience to live life courageously in the face of adversity, and sometimes, just when you think things are getting better, bam! You are knocked down again by another crisis.
Life seems to be all about the process of reaching the pinnacle, being knocked off of it, and working your way back up slowly and painstakingly. I once believed that there was a point in everyone’s life when things kind of came together for them, and then they would ride off into the sunset without a backward glance. Now I know better. There are no happily-ever-afters. There are just happy-for-nows.
Although I never would have believed it the day Erica told me my baby had died, I did in time recover from my miscarriage, which is to say, I sometimes remember the time with sadness, but I have moved on with my life. Yes, it has helped that I was fortunate enough to be able to give birth to a healthy baby girl eighteen months later, and a second son, also healthy, five years after that. And that my mother recovered from her surgery and went on to live another nineteen years. There have been ups and downs over the years to be sure. One of the biggest “downs” was being diagnosed with breast cancer in October of 2006. But I have to quickly look on the bright side even of that. My cancer was caught early, and I was given an excellent prognosis, as good as anyone can get, although I understand now even more completely than I did 21 years ago when I had the miscarriage that there are no guarantees in life. Life is completely what you make it, and if my mother taught me one thing in life (and she taught me plenty!) it is always to look on the bright side and count your blessings. My mother’s cup was always full to the brim, never half-empty or even half-full. I strive every day to emulate her.
Which brings me around to the beginning of the story. Six months ago when I was told I had to have a uterine biopsy, all I could think about was that this was somehow related to my molar pregnancy/miscarriage, and that I had been unwittingly harboring some kind of insidious slow-growing cancer inside my uterus for the past two decades. I was relieved to eventually receive a clean pathology report, along with the assurance from my gynecological oncologist that benign fibroids were the culprit this time.
I know this isn’t necessarily the end of the story, and that there will in all likelihood be other challenges in my life, possibly more cancer, and almost certainly more biopsies. The label “high risk” has stuck to me permanently now. I also know though, that I contain within me the capability for dealing with adversity, and for living life fully, and with courage. And perhaps that’s the most lasting legacy of all from my miscarriage.
Cara Holman joined The Women with Cancer Writing Group at Oregon Health & Science University after a cancer diagnosis three years ago. Since then she has had over three dozen personal essays, creative nonfiction stories and short form poetry published both online and in print anthologies. She blogs about books and writing at her blog Prose Posies .