The Miscarriage – From Naivety to Reality: Part 3

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The two weeks following the misoprostol were difficult to say the least.  I smiled less, I cried often.  I did my best to put on a brave face at work, but on the inside I was broken.  My bleeding was a constant reminder of our loss.  I felt empty.  I was empty.

I had gotten up for work on a Friday morning, almost two weeks after the misoprostol, and felt like I was finally seeing a small light at the end of our hellish tunnel.  I had hardly bled at all the last two days, and I finally felt like I was getting back to “normal”.

That afternoon at work, I felt a sudden gush of blood into my underwear.  I had a diva cup inserted, so I was a little taken aback that I had filled all 30 mL of it and then some.  I carefully made my way to the bathroom to empty the cup and then carried on with my day.  I didn’t think much of it, until an hour later I felt another huge gush of blood.  What the hell was going on?!  I thought this nightmare was coming to an end.

I waddled my way to the bathroom and discovered I had filled my diva cup yet again and bled all the way through my panties and leggings.  I embarrassed and scared.

My clothes were too blood-soaked to put back on.  I still had to see another three patients that day, there was no way I was going to sit at my desk with no panties and blood everywhere.  I tried to maintain my calm, as my mind flicked through the various outcomes and consequences of what was happening.  The nurses at the fertility clinic said that if I soaked a pad an hour, for two consecutive hours, then that was cause for concern.  Maybe the bleeding would slow down and everything would be fine.  I didn’t want to jump to conclusions.  I put my diva cup in and found a bag for my bloody clothes.  I talked to my manager and explained the embarrassing situation.  As I explained to her what happened I started crying and she told me to do whatever I had to do.

I grabbed my purse and walked to my car.  The second I stepped foot out the front door, I felt blood running down both of my legs.

Oh my god.  I couldn’t believe that my miscarriage wasn’t over.  It was only getting worse.  I didn’t think that was even possible.

I sat in my car and broke down.  I had no idea what to do.  I couldn’t go anywhere because I had no panties and blood streaming down my legs.  I didn’t know if I should go to the hospital, but even still I had blood leaking down my legs under my dress.  I would have left a trail of blood behind me and who knows how long I would have to wait.

I called one of my co-workers from inside my car.  I don’t even remember what I said to her, I was just crying and hyperventilating.  She got me an extra pad she had in her purse and a garbage bag to sit on.  I called my wife and she talked to me in the kind and calm voice that she uses when I’m freaking out.  I started to breathe and get my head straight again.  I felt physically fine and I knew I could drive home safely.  I just needed some goddamn panties and a pad and then I could figure out what to do next.

I drove the hour from Regina back to Moose Jaw trying to convince myself that everything was going to be okay.  I pulled into my driveway an as soon as I got up out of the car, blood was leaking out from the pad and running down my legs.  I ran inside to my bathroom and took my diva cup out.  I had filled the diva cup again, completely soaked the pad I was sitting on and there was blood everywhere.  I went into full panic mode, sobbing and shaking uncontrollably on the toilet.  I knew I was bleeding too much.

My poor wife started cleaning up around me and asked if we should go to emergency.  I still couldn’t think straight.  Deep down,  I knew I had lost too much blood that afternoon, but I wanted to check with the fertility clinic before I went into emergency.  Being a nurse, I didn’t want to go to emergency without a good reason.  I got into the shower to wash the blood off my legs.

I called the clinic and the nurse confirmed that I should go to emergency.  I heard some worry in her voice as I told her about how much blood I had lost that afternoon.  We gathered our things and headed to the hospital for my first emergency trip ever.

The emergency room was like everything else in Moose Jaw: small and quiet.  I was thankful for that because as we sat there I started to feel dizzy. A nurse took my vital signs before admitting me.  My pulse was 134.

I had never been a patient before.  After being assigned a room in emergency, I sat at the edge of the bed, adjusting to my surroundings.  Somehow, laying down on the stretcher would have been admitting there was really something wrong.  I was feeling better now that we were at the hospital.  My wife and I talked lightheartedly, to distract ourselves.  My bleeding had slowed quite a bit in the last couple of hours, which was encouraging.  I felt a bit silly for even being there.  Maybe I wouldn’t need a D&C after all.

The doctor on call was actually my family doctor.  It was a relief to see a friendly face.  He said that we would do some blood work and a speculum exam and the decide what to do from there.  My blood work was drawn by an awkward lab tech and we continued to wait, listening to the buzz of the emergency department around us.

My doctor came back in to the room a while later for the speculum exam.  Ugh.  I knew it had to be done, but I was not looking forward to it.  I laid back and scooched to the edge of the bed, with a wedge pillow under my butt.  I made a joke about how many people had been up in my private bits lately that I really didn’t care anymore.  But that was a lie.  I did care.  It was invasive and awful.  I hated it.

The doctor saw what he thought could be blood clots or products of pregnancy, but he wasn’t sure.  He wanted to do an ultrasound to confirm what was going on.

I walked down the hall to the ultrasound room.  The tech did an abdominal ultrasound first.  She said I still had a bit of urine in my bladder and that I should empty it in order to do a transvaginal ultrasound.  Oh great.  My favourite.

I went to the bathroom that was attached to the room and peed.  I stood up to wipe and gushed blood all over the floor.  How much blood could I possibly have left in me?!  I tried my best to wipe up the floor.  I told the tech what happened and apologized profusely.  I was overcome with embarrassment.

The transvaginal ultrasound was bloody and awful.  I felt so exposed and there was nothing I could do about my bleeding.  I just laid there and stared at the ceiling wondering what I did to deserve this.  The tech was very kind and said that it wasn’t my fault when I kept apologizing for bleeding everywhere.  She said she couldn’t tell me anything she saw on the screen and I would have to wait for my doctor to tell me the results.

As I walked back to my room, I felt another gush of blood.  That continued for the next couple of hours as we waited for the results to come back.  I finally resigned myself to laying down on the stretcher.  I felt tired and defeated.  I just wanted some answers.  I just wanted this nightmare to be over.

The doctor came back into the room and shut the doors.  He told me that the ultrasound had shown some retained tissues from the pregnancy.  He said that though my condition was not emergent, it was urgent and that I would need a D&C the next day.  My worst fear was coming true.  I immediately asked if I would be under a general anesthetic and he said that likely I would be.  That made me feel marginally better.  I started to cry for the first time since being admitted.  I had done so well putting on a brave face.  But that all came crashing down when I knew that a D&C was inevitable.

Somehow we managed to sleep a little bit that night and then we headed to the hospital bright and early the next day.  After checking in, I put on a hospital gown.  It was then that I really felt like a patient.  I sensed all of my autonomy and confidence slowly drain out.  I suddenly had so much empathy and respect for patients I had looked after in the past.  I never truly realized how powerless and frustrating it was to be a patient, especially in a hospital setting.  In the whirlwind of crap that I was dealing with, I felt a small pang of gratitude to have had that experience.  The nurse in me knew that this experience would probably make me a better nurse down the road.  Maybe it’s strange to have felt that just from the folds of an uncomfortable, snowflake-patterned hospital gown, but that’s what I felt.

As an aside, who decided that snowflakes were a good pattern for like every hospital gown ever?  Ew.

The gynecologist who was going to do my D&C came in to speak with us regarding the surgery.  His smile was nice, but his eyes and body language said that he didn’t really care all that much.  He wanted to do another ultrasound, as I had bled a considerable amount last night, just to make sure the D&C was still necessary.

Sure enough, the abdominal ultrasound showed small patches of white in my uterus, indicating that there were still tissues present.

As I began to ask him questions about the procedure, I quickly discovered that he had no interest in informed consent.  I asked him when my period could be expected to come back and about the risks of the procedure.  He said he didn’t know when my period would come back and that there were no risks to a D&C.  I asked about Asherman’s Syndrome, which is a rare complication leading to infertility, and he just waved his hand at me dismissively at me saying that it was nothing to worry about.  He also said that I could just as easily take another dose of the pill and not have the D&C at all and that it was up to me.  He left the room for a few minutes to let us decide.

Well, great.

For the umpteenth time in this whole process, I was glad to be a nurse.  I was already decently informed of the risks of a general anesthetic and had done my own research on the D&C procedure.  But I kind of wanted to discuss it with a real live doctor who specialized in gynecology to make sure that I was making a good decision.  Apparently that wasn’t going to happen today.  It’s no wonder people regularly turn to “Dr. Google” and message boards on the internet.  If you get stuck with a doctor who doesn’t care about you, unfortunately you don’t have anywhere else to turn.

My wife and I talked about what we were going to do.  I was really scared of the D&C.. Though it was irrational, I kept having horrible thoughts of never waking up from anesthesia.  Any surgery is risky and I wanted to avoid those risks, if possible.  Still, but clearly the pill did not work for me the first time and I really did not want to go through all of that again.  Again, I was stuck choosing the lesser of two evils.

The gynecologist came back into the room and asked if we had decided because the anesthesiologist was on her way and if we weren’t going with the D&C then she wouldn’t bother coming.  His tone made it very clear that we were at the bottom of his priority list.  Apparently the schedule of the anesthesiologist was more important than this critical decision to have surgery or not.  I looked at my wife and then told him that I would have the surgery.

After an hour and a half wait, I was wheeled to the operating room.  The bright white lights and air of sterility greeted me, reminding me of my scrub nurse days.  All of the staff were women, which made me feel slightly more comfortable.  I walked to the operating room table and laid down as the anesthesiologist started asking me questions.  Through a veil of numbness, I felt the hustle and bustle of nurses attaching cardiac and vital signs monitoring to me.  I thought of all the times I had prepped a patient for surgery and realized how nervous they must have been, as I put a blood pressure cuff and a warm blanket over them.

I looked up at the ceiling covered with fluorescent lights, a sight that was becoming all too familiar to me, and the anesthesiologists face came into view.  Her eyes looked kind and I imagined what her face looked like underneath her mask.  She asked me if this was my first baby.  Hearing the word “baby” made me burst into tears.  Since the miscarriage everyone had referred to the “products of pregnancy”, which while medically useful, is a very dehumanizing term.  It was like everyone just wanted to pretend that my baby was never there.

I hurriedly explained through my tears that I really wanted this baby and that I was a nurse and that this was not how I ever imagined things would turn out.  The anesthesiologist wiped tears from my eyes with the flannel blanket and said that everything was going to be okay.  This happens to a lot of women.  You’ll have another baby, she told me.  I felt so ashamed of how my body had failed.

She announced that she was giving me a dose of midazolam, which I was so grateful for.  Everything got fuzzy and I felt wonderful.  All of my worries were suspended temporarily as I unknowingly drifted off…

The next thing I knew, I was flicking my eyes open in the recovery room.  The lights were dim and I felt the pressure of the cuff on my arm, as my nurse took my vital signs.  She said that my wife was waiting for me at the end of the hall.  I was so thankful to have woken up.  I felt relaxed and a little dizzy.

I dozed off and woke up to my wife coming in to the room.  I was so happy to see her face.  She read to me a little bit, as I slowly had some apple juice and the most amazing piece of toast with peanut butter on it.  Seriously, guys.  That toast was out of this world.

I walked slowly to the bathroom for the obligatory pee before I was able to go home.  I got my discharge instructions and felt like a princess as a porter wheeled me down to the front door.  I hoped that all of the kind staff I encountered was some sort of nursing karma for the compassion and care I’ve shown my patients over the years.  Either way, I was grateful to step into the sunshine and go home.

The next two days were full of sleep, tears, Netflix, cuddles and comfort food.  I was anxious about taking too much time off because I wanted to save my sick time for future fertility appointments.  I wish I could have taken more time off to really process what happened to me.

I let life whisk me away and I kind of left my emotional health in the dust.  I’m dealing with it as best I can now, with meditation and exercise.  Everyday is a little bit better, but if I’m being honest with myself I’m far from being in the clear.  I put on a smile because I’m pretty good at faking being happy, but I know deep down I have some healing to do.  I’ve been more gentle and compassionate towards myself than I ever have been in my life, which is an area in which I’ve been wanting to grow for some time.

People have said to me that everything happens for a reason and that this experience will make me a stronger person.  I’ve been told that it will happen when it’s meant to happen.  I’ve been told to focus on the positive.  I’ve been told that everything has a silver lining if you look hard enough.  But you know what?

Fuck that.

There is nothing good about my baby dying.  There is no positive thinking that will take away the pain of losing her.  I did not need this traumatic experience to become a stronger person.  I was already strong to begin with.

-K

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The Miscarriage – From Naivety to Reality: Part 2

After finding out about the miscarriage I sat in the doctor’s office crying, overwhelmed and at a complete loss of what to do.  My initial instinct was to get as far away from any medical technology as possible.  I could not even fathom any type of abortion procedure at that time; it made me sick.  After we had adjusted to our new normal, I realized that I couldn’t wait for the miscarriage to happen naturally.  Being as far along as I was, with my hCG levels as high as they were, it could take weeks for my body to miscarry naturally.  The extra cruelty of a missed miscarriage (as if it could be any more cruel), is that my body thought it was still pregnant.  The pregnancy symptoms I had been experiencing were still in full force.  Morning sickness and exhaustion would be well worth it, if it was for the benefit of my little one growing inside me.  To experience those symptoms knowing that I would never hold my baby was just pure torture.  I had to do something.

After doing some research online and speaking with the nurses at the fertility clinic, we scheduled another ultrasound to be done one week after we had received the terrible news.  If there was no heartbeat and no development at the second ultrasound, we could be sure that the pregnancy was not viable.  As a secondary confirmation, I would also have my hCG levels measured again.  If my hCG had dropped from previous testing then we could be sure of the miscarriage.  There was no way I was ending my pregnancy without full confirmation that it was no longer viable.  I couldn’t live with myself without knowing for sure.

Every time the fertility clinic called to check in, I told them I still felt as pregnant as ever.  I felt so betrayed by my body.  I never had any spotting or bleeding or cramping.  No signs whatsoever of the death that took place.  My baby just slipped quietly away, without me even knowing.

The fertility clinic was such an amazing source of support for me during this time.  Suddenly, the hundreds of dollars of clinic fees seemed totally worth it.  A few days after we found out about the miscarriage I called the nurses to get some more guidance.  I was sitting in my car during my lunch break, as our office walls don’t provide much privacy, and started asking about my options.  I soon broke down into tears.  The nurse was so sweet and understanding.  She listened to me cry and said that it was a terrible thing that was happening to me.  It was the first time someone had said that to me and it felt so validating.  She didn’t try to tell me that everything was okay or that I’d have better luch next time.  It was a terrible thing.

A couple days before the second confirmation ultrasound, I knew I had to figure out what I was going to do if we found out for sure that the pregnancy was not progressing.  We had three options: (1) expectant management (wait and see); (2) medical management with misoprostol to induce abortion; or (3) surgical management with dilation and curettage (D&C).

Each option sounded worst that the last.  I never dreamed that after working so hard to get pregnant, I would have to work even harder to end my pregnancy.

Before I go into how we made our decision, let me say that there is no one-size-fits-all choice for everyone.  Unless there is a medical emergency, there is no “right” answer.  Each option comes with it’s own consequences and each person needs to make a choice that suits them in their circumstances, in conjunction with their health care provider.  I spent hours reading stories about all three options, all with extremely different outcomes.  Reading through the stories of people who have had to deal with miscarriages helped me determine what was important to me, which led me to make the decisions that I did.  My experiences that follow are in no way a substitute for medical advice, nor are they a guide for how every woman should handle a missed miscarriage.  This was just how my story unfolded for me.

Expectant management simply was not an option for me.  I could not imagine weeks of waiting for bleeding to start.  Many women opt for this choice, as they feel it is more natural and doesn’t involve any intervention.  I completely agree and that was my initial reaction to finding out about the miscarriage.  Perhaps if I wasn’t as far along I would have waited.  Based on my hCG levels, it would be weeks before my body figured out that I was no longer pregnant.  The other downside is that there was a risk of infection, as the remaining tissues from the pregnancy would be in my uterus until my body could expel them.  I guess didn’t have the courage to wait it out, and maybe that makes me weak.  I just couldn’t bear it.

The second option of medical management seemed to be the middle ground between an invasive D&C procedure and waiting for the pregnancy to pass naturally.  Using the misoprostol pill, I could have the miscarriage in the comfort of my home (not that there was going to be anything comfortable about it), in my own time and with the support of my wife.  There would have been a day or two of downtime following taking the pill and then we could move on.  The nurses at the fertility clinic said that when the pill works, it works very well for most women.  There is bleeding for 1-2 weeks and then it’s done.  The risks of this option included excessive bleeding, uterine rupture and not fully passing the products of the pregnancy.  If the pill didn’t work, then a D&C would be the next step.

The D&C would have been the fastest way to deal with the miscarriage, but the procedure sounded so awful.  I kept imagining myself, legs wide open on the operating table, vulnerable to the world on the operating table with a doctor digging around in my uterus, scraping out the remains of my pregnancy.  I had horrible visions of only being under conscious sedation (instead of being put totally under) and feeling the pressure and pain of the instrument inside me.  It filled me with such anxiety that it made me cry just to think about it.  I already felt so traumatized by the whole experience, that I wanted to handle the miscarriage quietly, on my own terms.  The risks of a D&C included the usual risks of any surgery (bleeding, infection, anesthetic etc), as well as scarring from the procedure, potentially leading to infertility.  This is known as Asherman’s syndrome, and it is extremely rare, but I didn’t want anything ruining my chances of getting pregnant in the future.

Medical management seemed to be the “best” option for me.

I called the fertility clinic on Friday to request a prescription for misoprostol and a pain killer, to ensure that it was ready for me on Monday after the ultrasound.  If we got the confirmation we were expecting, I couldn’t wait another day for the miscarriage.  I just wanted to move on.  The nurse I spoke to agreed with my decision with gentle encouragement.  The nurses never once told me what to do, but said that whatever I chose would be a good option.  She said that the pill works within a few hours and it was very effective for most women.  I hoped that I fell into that category.

On Monday, our nightmare was confirmed.  My wife and I handled the news in a matter-of-fact way, though our hearts were heavy with sadness.  We were much more prepared for the disappointment.  I don’t think it made anything easier, we just didn’t feel the shock that we had at the last appointment.  We knew the miscarriage had happened, but we wanted confirmation in order to move on.  In addition to the ultrasound showing no progress or heartbeat, my hCG levels had also dropped slightly.  Now we knew for sure.

We went straight to the pharmacy to pick up my prescription.  To make matters worse, the pharmacist could barely look me in the eye when he handed me the misoprostol.  He obviously knew that the medication was for an abortion.  He mumbled something about inserting the pill vaginally and that there would be no side effects because it was a local application.  He didn’t say anything else and awkwardly handed me the bag.  I felt so embarrassed and angry.  I wanted to tell him how much I wanted my baby.  I wanted to scream at him that I never wanted this to happen and that he should act like a professional and give me the information that I needed without judgement.  No side effects?!  How about bleeding excessively or uterine rupture?  How about intense nausea and diarrhea?!  He also told me only to take the T3s if I had pain, as if I was planning on going home and getting high on codeine. I was so upset.  After such a painstaking and devastating decision, to be treated with such disrespect was a slap in the face.

I tried to brush off the negative encounter and hoped that I was maybe just particularly sensitive given my present circumstances.  My wife and I picked up grapefruit juice, a McCain’s chocolate cake and some ice cream.  I knew emotionally eating is really counter-productive.  Given what I was about to go through, I really didn’t care.

At home, I nervously unpackaged the misoprostol and, like a good nurse, carefully read all of the instructions and side effects.  Contrary to what the incompetent pharmacist had said, there were side effects even when the pill was inserted vaginally.  I inserted the 800 mcg dose, which was 4 tablets total.  The tablets were uncoated and awkward to insert.  The medication is actually for stomach ulcers, with an off-label use for inducing abortion early in pregnancy and inducing labour.  The nurse at the fertility clinic told me sometimes it only takes an hour for the pills to work.  I put on a pad and anxiously awaited the effects.  My wife and I got into bed, and started watching Voyager (I may be a bit of a Trekkie) and had some cake.  I was so glad to have her there with me.  I couldn’t imagine going through it alone.

Five hours later I began cramping.  It was worse than any menstrual cramps I have had.  I read that the sensation is very similar to contractions, so I tried to breathe through them, imagining that they were practice for labour later on down the road.  I was glad I had taken a T3 and an ibuprofen earlier.  The cramps were so bad I was just moaning and breathing, lying on my side, hoping they would be over soon.  Then the cramps subsided a bit and I was slammed with a huge wave of nausea.  I jumped out of bed and almost missed the toilet.  I vomited violently five or six times while my wife rubbed my back and held my hair.  No side effects, my ass.

The nausea retreated as quickly as it had come on and I was back in bed dealing with the tail end of my cramps.  The cramps only lasted an hour, thank goodness, but I had not actually bled yet.  It was very late at night, since I was not expecting the misoprostol to take so long to work, and I ended up drifting off to sleep.  In retrospect, this was probably a little bit dangerous as I could have bleed excessively in my sleep.  I woke up in the middle of the night and went to the bathroom.  As soon as I stood up, blood was running down my legs.  I had completely soaked the pad I was wearing and could feel clots and blood passing as I sat on the toilet.

I was both relieved and totally heartbroken.  As I was getting back into bed, I remembered that some women had kept the tissues they passed to bury them.  I felt like I was a terrible mother for not showing more respect for the life inside me.  But I didn’t know what else to do.  I didn’t know what I was supposed to do.

I was so emotionally drained.  I hoped everything would seem better in the morning, but I knew it was probably going to be worse.

I rested for the next two days at home, which I felt guilty about because I needed to save my sick time for the next round of IUI.  But I was exhausted and depressed and still having frequent outbursts of tears.  I was also still bleeding quite a bit and I really didn’t feel like I could deal with that at work.  I watched Netflix and my wife brought me cake when I asked for it and we cuddled.  We did the best we could to grieve and comfort each other.

During those two days, we also received a lot of support from our close friends and family who knew about the pregnancy.  Every text, Facebook message and phone call was so very appreciated.  One of my amazing friends back home sent us a wonderful care package with a vegan cookbook and a kilogram of gummy bears.  You can bet I ate every single one of them in less than a week.  I understand why people want to keep pregnancy and miscarriage private.  At the same time, having all of the support of our friends and family made everything so much more bearable.  Every time someone asked me how I was doing, it allowed me to process and express my grief.  Don’t get me wrong, it hurt like hell.  But I think it was better than hiding all of that hurt in my heart.

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As I said in my last post, the misoprostol did not work for me and I ended up bleeding so much that I soaked through my clothes at work two weeks after taking it.  This resulted in a trip to emergency and a D&C procedure, the details of which will be in my next post.

Despite my initial pangs of regret for telling everyone that we were pregnant, I now am so thankful that we don’t have to hide the pain we are experiencing.  Countless friends and family members have reached out to us, offering condolences, compassion and care packages, for which we are so incredibly grateful.  Knowing that we are not alone has made this dark time in our lives a little bit brighter.  Thank you for reading and for being a part of our journey.

-K

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