Monday, February 11, 2008

A Hard Day's Night

Since I find myself thinking about certain angels at certain times of the year more than at others (as do we all), it made more sense to me to make blog entries going by anniversary date rather than in chronological order. February 8th is the anniversary date for the loss of my 9th pregnancy and 6th miscarriage. This pregnancy differed from my other pregnancies and losses in many ways. I started up on Follistim this time around, since I had clearly become resistant to the Clomid. After 13 cycles of clomid at increasing doses and then finally Follistim, I conceived my 8th pregnancy and happily delivered a healthy baby, albeit a healthy baby with immature lungs, at 36 weeks. Since my endometriosis was becoming worse, my doctor recommended taking the minipill following delivery - not so much as birth control (since my annovulatory status kind of made contraception a moot point) but to try and help keep the endo in check. She knew we wanted at least one more baby and felt this would "buy us" some more time. I stopped the minipill in December of 2001 and started the Follistim conceiving that first month. The cycle was extremely painful. My ovaries usually ached pretty good midcycle whenever taking the Clomid or Follistim, often feeling like they had swollen to the size of grapefruits - heavy and painful. However, usually after ovulation, the aching would begin to subside. This time however, the ache never subsided and seemed to worsen almost daily. I have a bit of a theory that the minipill had left me with cysts going into the Follistim cycle leading to the problem, as I have only ever developed cysts when taking the pill. I never developed cysts on all the Clomid I took and not the time before or since that particular cycle when on Follistim. One day I woke up and began my usual daily routine and discovered I could not move for pain. I was trembling and hot and standing up straight was near impossible. Laying on my couch I called my doctor. She scheduled me for an ultrasound the following day - being that she was an almost 2 hour drive away for me, the next day was a better option. My lab tests had been beautiful so far - my beta hcgs were more than doubling, almost tripling - giving my doctor the impression that an ectopic pg was unlikely to be the source of my pain. My progesterone had been solidly in the lower 50's, and I had been taking Prometrium since a few days following ovulation. The next day I and a friend (because I was hurting enough that driving for that long a distance was an iffy proposition) headed to St. Louis for my scan. I went to the office that had handled my dosing and follicle scans for the ultrasound. (As a side note - any readers who live in the St. Louis area, Becky Kubala and staff at Parints are wonderful - they took amazing care of me and also helped to match me with a wonderful doctor. Anyone needing infertility care would be be well taken care of by them.) The tech doing my scan found that I had multiple cysts on my ovaries and free fluid indicating some of them had ruptured - these were very likely the cause of much of my pain. In addition, she found evidence of bleeding in my uterus as well as two gestational sacs. I have to admit a slight thrill at the thought of twins! This would be the first time I had conceived multiples! This thrill was shortlived as she also noted that she saw a "something" between my right ovary and uterus that had her thinking I also had a tubal pregnancy - a very painful and very not good situation. At 5 and a half weeks, it was difficult to say exactly what the something was for sure. She phoned my doctor's office and explained her findings and told me I was to head over there right away. I arrived at Dr. Matuszek's office and was ushered in immediately. She also did an ultrasound and I could see by her downward turned mouth she was not happy with what she was seeing. She didn't want to start methothrexate (a chemotherapy drug often used in treatment of ectopic pregnancies as a non-surgical means of ending a dangerous and potentially life threatening pregnancy - you simply cannot grow a baby in a tiny straw) in hopes of possibly making something of the uterine pg(s), however, the other something bore careful scrutiny. I was sent home with instructions to avoid salt, drink lots of fluids, avoid lifting and lay down a lot and return in a week for another scan. I was also given strict instructions as to what to do should my pain return, worsen or I began bleeding. I lasted at home about 4 days. The pain from the ovarian cysts was subsiding, but the pain from the ectopic pregnancy was escalating. I had also begun spotting and bleeding - brown, old blood off and on. I called my doctor and I could hear in her voice, though she never said it, that this pregnancy was not going to be continuing much further - her focus was more on taking care of me and making sure I was okay. I took some Advil, a warm bath - all hoping to alleviate the pain I was feeling, hoping that it was just more ovarian cysts. The Advil and bath did nothing to help. The pain in my right side crackled across my entire abdomen - hot and branching out like lightning. I read the book that I had bought when I had become pregnant for the very first time "What to Expect When You're Expecting" on ectopic pregnancies. I had never looked in the book again after my first few miscarriages - most of the information just didn't seem to apply to me anymore. Plus the happy nothing's wrong tone didn't help calm my fears and anxieties when I was pregnant with subsequent pregnancies, all going well or not. However, their information for ectopic pregnancies - while brief, was spot on and described precisely what I was feeling. I could no longer hope that things were going to turn out any other way then the direction they were clearly headed in. I still held on to the hope that maybe we could take care of the tubal pregnancy surgically and the two little intrauterine sacs we saw on u/s the week before might grow and flourish. I bargained, I pleaded and prayed - I made arrangements for my children to be watched by a friend and my husband and I began the long silent drive to the hospital in St. Louis.

We arrived at the hospital a bit after 11 in the evening. I could barely walk, hunched over because the pain made it impossible to stand upright. I was shaky and tears often worked their way down my face. I blamed it on the pain - but much of it was tears of disappointment and feelings of failure. Because of the late hour I had to go in through the Emergency Room. We sat for a brief moment in the waiting area watching The Tonight Show. They were doing their JayWalking bit and the nurse hustled us out about the time I began yelling at the tv "Francis Scott Key you bleeping moron! What kind of American doesn't know Francis Scott Key wrote the national anthem??!!" It's funny the things you remember. Part of our waiting involved an ultrasound technician being called in to verify what was going on in the part of my body I had started referring to as the Bermuda Triangle - things go in but don't come out. That particular ultrasound will go down as the most painful ultrasound I have ever had and the less than friendly tech didn't help to make matters much better. She found that I was bleeding out both ends of my tube. My right fallopian tube was bulging and ready to burst. Of the two sacs in my uterus that I held such hopes for - one was almost completely gone, the other was smaller and losing definition. No sign of anything ever having developed in either of them - no fetal pole, no yolk sac - nothing. I turned my face to the wall while she finished her scan - not wanting to see the nothing that was left of this pregnancy on the monitor.

My doctor came in while they were prepping me for the laparoscopy. While signing the forms I tried to ignore the terminology - the fact that I was signing to terminate my pregnancy. She knew my heart was breaking - we had walked this path together before, good and bad outcomes. At a later follow up visit she confided to me that she had had a tubal pregnancy herself many years before. She knew how badly I had wanted that pregnancy. She promised me she would do her utmost to try and save the tube, especially since as I reminded her - the right side was my "good" side. The side that always produced the best follicles and the one ovary that actually was in the right position. (Endometriosis has left scarring and adhesions that have pulled my uterus to the left and also "bound up" my left ovary pulling it out of position, high and back, making it difficult for a released egg to make it into the fallopian tube, let alone be seen during a scan. Every scan with a new tech always brings the same question "Do you have a left ovary?" and then when I say I do, they go hunting for it - always a treat when they go poking and prodding for that thing. Sorry - I think you just found my liver there . . .)

She saved the tube. By the time I got in there it began rupturing which is why I started feeling better shortly after the scan - the tube had finally given. That and blood loss added to an almost euphoric sense of physical "relief". I ended up having a laparoscopy for the tubal and a d&c for the intrauterine mess. The embryo that had implanted itself in my tube had been healthy and viable - just had the misfortunate circumstance in being in an impossible spot. Just a cm or two further and we could have been okay. The two in my uterus, while capable of finding the right spot - just didn't have the wherewithal to make something of themselves. I woke up in recovery and immediately wished to not be conscious. I hurt everywhere and opening my eyes was something I was not ready to face just yet. When I was ready to open them, the recovery room nurse smiled and said cheerily "Oh! You're awake!" She was pleasant, I wanted to die. She also seemed to think that I was ready to go home a mere 2 hours after surgery. I let her get me ready to go - I wanted to go home, I wanted to sleep, I didn't care. Unfortunately, this set in motion even more fun events. I knew I couldn't sit upright for the hour and 45 minute ride home, so I crawled into the back of our minivan. We think that when I did this - one or two of the veins that had been cauterized in my naval incision for the laparoscopy slipped free and began free bleeding, which I did not notice at first. The nurse gave me one of the warm hospital blankets to help keep me warm in the car for the ride home. We left a little after 4 in the morning, surgery had been at 1:30am. Almost an hour into the trip I became a bit more lucid and began to sit up a bit and noticed to my shock that I was wet literally from the waist down. I was covered in blood and looking at my incision, I could see bleeding through the bandage and literally coursing down my abdomen. Lots of bleeding kind of snaps you into a bit of clarity. At this point I told my husband what was happening and he asked me what I wanted to do. Okay - sure, ask the lady who just had surgery and is bleeding to death in the back of our minivan what SHE wants to do. Find a hospital - any hospital. So we stopped at a hospital about 45 minutes from the hospital we had just come from and about an hour from home. Now they were confused - they were confused why I was bleeding, confused why I was on the road, confused why I had a hospital blanket wadded up and pressed to my stomach like a pressure bandage, confused why I had just had surgery and was not still in a hospital somewhere else. They called my doctor who was confused as to why I was not still in her hospital. (Somewhere sometime I think the cheery recovery room nurse got a bit of an earful and a "what were you thinking?" lecture). Then we sat there staring at my belly, literally contemplating my naval when I realized that gee, I really don't feel so great and I am kind of hot and dizzzzyyyyy . . . . I remember the ER doc's head looking up from my bellybutton to me , putting both of his hands on my shoulders and then I am staring at the ceiling.

I got a stitch in my bellybutton. I asked for my blanket before they sent us home. Matt said it was all bloody and they threw it away. I told him I wanted the blanket. "Honey, it's in the trash." I don't care - I want that blanket. We are arguing over the blanket. Finally, I appeal to his frugal side, "honey, you know they charged us $250 bucks for that blanket, because nothing is free at the hospital, so we are keeping it and getting our money's worth!" I made him get the nurse to fish the blanket out of the trash. They both told me it was hopeless and probably never would come clean. I didn't care - I had to have that blanket. That scratchy, worn blanket that had probably covered a hundred prior patients and now was soaked with my blood. I had to have that blanket because when I first opened my eyes after my babies were gone - it was the only warmth I felt. I washed it, I bleached it - it came clean. I still have it.

This year, as a fitting homage I suppose, my period started on the 6th anniversary of my surgery. I wrapped myself up in the blanket with a hot water bottle. (and a lot of ibuprofen)

At the end of my posts about my angels I put their names - I need to explain this name. Because this had been a multiples pregnancy I wanted something to recognize that, but I was stumped. A good friend from Spals helped me come up with a solution - Matthew Thomas. Thomas means "twins" and Matthew means "Friend of Thomas". I was able to recognize all three. I'll talk about naming my angels later. I will say for now though - that giving them names was a big part of healing for me.

Angel Matthew Thomas 2/2002

1 comment:

loribeth said...

I can remember you writing about this on SPALS, though not all the details. Reading about it again, I've always been amazed (& continue to be!) at everything you've been through to get the family you wanted. (((hugs)))