Miscarriage, Act III: There Will be Blood

Tuesday evening, three weeks to the day after the disappointing ultrasound, the miscarriage began in earnest.  And when I say "earnest," try to picture that scene in The Shining with the elevator doors.  In retrospect, now that I'm home from the hospital, I know that what was happening was not just surprisingly heavy flow, but a hemorrhage.

I called my OB's office and got juggled by incompetents at their answering service for a while, finally got a call back from the on-call doctor, who wasn't a member of the practice.  He prescribed Methergine, a hormone, to slow the bleeding.  Andy went and got it, and I took the first dose at 9:30 PM.

It was a scary night, and one of the worst things was having to make the judgment call myself.  The standard is soaking through a pad an hour; more than that, and you're supposed to go the ER.  But that's an extra-tough call to make when going to the ER involves waking your sleeping toddler and hauling him off with you.  After the Methergine kicked in, the bleeding slowed, but I was still soaking more than a pad an hour, and I was passing some pretty horrifying clots.  Tissue (normal) or clots (if large, worrisome)?  How was I supposed to know?  The trend was positive -- I was definitely bleeding less.  So I stuck it out, and after the second dose of the hormone, around 2:00 AM, the bleeding slowed significantly, and I was able to sleep until 6:30.

In the morning, everything seemed fine.  Bleeding like a normal period.  I called the OB's office, and they said I should come in and get checked, which I did at 11:30.  Andy took the day off work.  I saw the midwife, she did a pelvic exam, and everything looked normal.  In her opinion, I'd just had an all-at-once miscarriage, and though she could still see some blood and clots, she expected that I wouldn't bleed heavily again, and probably not for long.  So, good!  Hurray for that.  Such relief.

We got home around 1:00, and the heavy bleeding started again.  I called the office, and by the time the midwife called me back, I was beginning to feel light-headed.  I should have mentioned it, but it didn't seem significant, especially since I'd hardly eaten all day, and I'm prone to feeling light-headed when underfed.  She told me to take the Methergine again, but if I was still soaking a pad an hour after four hours to go to the ER.  I took the Methergine at 2:30 and went upstairs to try to nap.  I slept some, but mostly I just lay in bed and bled and worried.  When I got up at around 5:00, I had to sit down at the bottom of the stairs because I felt like I was about to black out. 

So we went to the ER.

The admitting doctor was a putz.  He asked me how long my OB would "let me" continue bleeding.  I told him what the midwife had said about four hours post-Methergine, and he started arguing with me in way I didn't entirely understand.  I explained that I expected -- and I assumed my OB practice expected -- that going to the ER meant I would get a D&C at the hospital.  The doctor said no, the ER would refer me back to the OB.  That seemed crazy, but I wasn't about to argue with him, since I figured either another doctor would be less stupid or someone would call my OB.

They wheeled me into the inner section of the ER, and Ben became blessedly absorbed by Cars and Trucks and Things That Go.  Eventually another doctor came in, who began by asking me how I knew I was pregnant, which flummoxed me completely.  Uh, because I know how to pee on a stick?  So he got the whole history and concluded that I needed an ultrasound before they could determine any course of treatment, which seemed entirely sensible to me.  By the time they wheeled me out for the ultrasound, the bleeding had mostly stopped.  That was around 7:30.

Another doctor joined in the fun.  He said based on the ultrasound, which showed a small amount of tissue remaining, and the fact that the bleeding had stopped, we had two options: send me home with the caveat that if heavy bleeding started again, I was to come right back, and if not, go to the OB in the morning; or transfer me to Bellevue (the sister hospital a couple of miles away that handles all the OB/Gyn stuff for the hospital system) where they could keep a closer eye on me and possibly give me the D&C as soon as that night.  They wanted to take my vital signs again and consult with someone from my OB practice before making the call.  The vitals were what clinched it: they took them lying down, sitting up, and standing, and my heart rate was somewhere in the realm of crazy-cuckoo when I stood up, so no going home for me.  Which was fine.  The last thing in the world I wanted was to go home and start bleeding and have to haul the poor toddler out of bed and start this whole nonsense over again, but at some charming hour like 2:00 AM.

So Ben and Andy went home.  And let me take a moment here to sing the praises of my mellow and largely unflappable toddler, who sat quite happily in a chair looking at books and crashing toy cars together and watching Seinfeld and eating crackers and charming nurses until nearly three hours after his bedtime.  And Andy, for whom patience and calm do not come easily, who smoothly distracted Ben out of every possible turn into crabbiness and held my hand and didn't freak out even a little.  At around 9:30, they went home, and I waited for the ambulance.

The next few hours were kind of hard.  From the time we got to the ER, I felt enormously relieved that, whatever happened from that point, at least I wouldn't be the one making judgment calls, and if the crazy bleeding kept up or started up again, someone would know what to do.  But when Andy left, I felt alone, and sad to be alone.  I have lovely friends here who I'm sure would have jumped in the car if I'd called, but it didn't seem a dire enough emergency, my desire for further company and hand-holding, to get other mothers of babies and toddlers out of their beds at 10:30.  I'd have called my mom if she weren't three hours away.  I'd have called older friends with whom I have deeper credit, if they lived nearby.  Maybe.  It's hard to ask for help, even when you want it.

When the EMTs wheeled me into my room at Bellevue, I could hear a newborn crying.  The room was just down the hall from where I'd stayed when Ben was born.  I've never felt, throughout the loss of this pregnancy, that I was mourning a lost baby -- but ending this journey in that place was hard.  The doctor on call couldn't come talk to me because he was delivering babies.  I asked, when I woke up the following morning, how many babies they'd delivered that night.  The nurse said five, and I'm not even sure why I asked, because of course it made me cry.

No one knew whether I'd be getting a D&C that night, or in the morning, or not at all.  Which was fine, but it meant that I wasn't allowed to eat or drink, which sucked.  I was substantially dehydrated from all the blood loss, and I'd been getting IV fluids since arriving at the ER, but it didn't make me less thirsty.  They let me have a sip of water to take the Ambien which it was someone's excellent idea to give me around midnight, and handing that cup back demanded the kind of willpower I don't generally admit I'm capable of.  I wasn't hungry until morning, and then I had to start changing channels when food ads came on.

In the morning, I had another ultrasound and another blood draw.  The doctor (this time someone from my own OB practice) came in around 11:00, 12 hours since I'd been admitted and the first time I'd spoken to an actual MD, and said if I hadn't already lost so much blood, he'd be tempted to send me home to let the rest of the tissue pass normally, but he didn't want to run the risk that I'd start bleeding again, so he wanted to give me a D&C.  Which, duh.  I mean, I think I'd have burst into tears if he'd tried to send me home again.

They put me under for the surgery, bless them.  Not on-a-ventilator under, just knocked out and with a local.  So the surgery, so far as I'm concerned, was a total breeze.  I came to, dozed for a while in recovery, then got wheeled back to my room.  Most of my focus was on when could I eat something and might there be crackers and I have crackers in my bag if there aren't crackers here and can I eat crackers yet?  The nurse brought me saltines and ginger ale, and never have such things tasted so good.

Andy and Ben had come for a visit in the morning between breakfast (theirs, of course) and nap time, and I'd requested -- for my sake and Ben's, not so much Andy's -- that they not come back until I was about ready to be released, since I preferred to rest and watch something on TV other than Dora or Dinosaur Train.  After I gorged myself on crackers and further demonstrated my ability to function extra-hospitally by peeing, the nurse said it was just a matter of some paperwork (translation: maybe two hours) before I'd be free to go.  That was around 3:30.  I called Andy, and he and Ben came back.  I was home by 5:00.

The bleeding started Tuesday night.  I spent Tuesday night bleeding and freaking out, Wednesday night in two hospitals, and Thursday night sleeping soundly in my own bed.  Today is Friday.

In terms of the surgery itself, I feel absolutely fine.  I had some very mild cramping last night, wholly solved with ibuprofen.  No pain whatsoever today.  But I'm still feeling weak from the blood loss.  The doctor told me to take iron supplements, and I should have thought to buy some on the way home, but I didn't, and I don't think I should drive, so Andy's going to stop by the pharmacy on his way home from work.  Not feeling 100% up to kid-wrangling this morning with Andy back at work, I called in the cavalry, and two marvelous friends turned up to take Ben to the playground and wear him out. 

No sex for four weeks.  No attempting to conceive until after my next period, which will probably be in four to seven weeks.  If I'd had the D&C three weeks ago, of course, I'd be three weeks ahead of this schedule.  I think it's the timing I find most frustrating.  We would have started trying to get pregnant this past fall, but I needed several dental procedures that were best done before conceiving, and what with scheduling and waiting for pre-approval from insurance, that ran us into January.  I got pregnant in February, the first cycle trying, but it turned into a bit of a catastrophe, and now we can't even start trying again until the end of May at the latest, and probably more like the middle of June.  I'm 37.  The clock is ticking.

In the short term, right now, I'm feeling kind of traumatized.  My bathrooms freak me out.  Having always enjoyed rude good health, having my only experience of pregnancy before this an entirely by-the-book gestation and delivery, I'm finding myself pretty shaken, especially given my age, by the idea of the next pregnancy and all the things that can go wrong.  A miscarriage, even one that goes as badly as this one, is really the least of my worries.  It's like, once the possibility of this bad outcome was made manifest, the floodgates opened, and now all the bad outcomes seem far more plausible, far more threatening, far more real.