The life-and-death lessons of a misscarriage
I'm not the world's most spontaneous person. I don't take kindly to last-minute changes in dinner plans or to people switching the screensaver on my computer. And it's not just the little things. I went directly from high school to the college of my choice, graduated on time and then got married before I got pregnant. When I did conceive my first child, the event was precisely scheduled for a summer delivery, ensuring that I'd be able to stay home for a couple months before going back to work as a school librarian.
Living such an orderly, predictable life has been a comfort. Less defensible, though, is the way I used to wear it as a badge of merit. People whose vitae didn't follow the standard story line were, unlike me, either willfully contrary or woefully disorganized. Or so I used to think.
Sixteen years ago, I found out what it feels like when plans go awry. We were living in Los Angeles, where my husband was attending graduate school. Our daughter Sophie was 18 months old and I was in the first trimester of my second pregnancy -- like the first, a conscientiously conceived condition. It was Friday the 13th. The following morning -- Valentine's Day -- we were moving from our one-bedroom apartment to a larger unit down the block. Our phone had already been disconnected and just about everything we owned was packed in boxes, ready to go. Just before bed, I went to the bathroom and noticed a little bleeding.
"Remember with Sophie?" David soothed me. "It was just about three months and you had some spotting and Dr. Parker told you not to worry. For it to be a problem, there has to be a lot of blood."
Around midnight, there was: decisive clots dropping into the toilet like balls of red wax from a candle. Reluctant to give what was happening a name or disturb my sleeping family, I did my best to clean the blood smeared on my thighs, thick as raspberry jam. With a wad of toilet paper stuffed between my legs, I found my way between the boxes to my unpacked purse and the Kotex napkin I kept there in case of emergency. Then I crawled back into bed and whispered my bad news to David. "I'm miscarrying."
Miscarriage is one of those words people don't like to say. Even before I understood the facts of life, I associated the term with words like feces and incest -- not suited for polite conversation. The sound made me think of a tragically mangled perambulator -- its seat overturned, its wheels badly twisted. The image wasn't so far off. Miscarriage suggests a failure to transport something to its intended destination. Biologically speaking, the developing baby is the cargo, the intended destination live birth, and the vehicle of transport the mother.
When a pregnancy fails -- as about two in five do -- it's usually because chromosomes haven't properly replicated, or the newly formed zygote hasn't successfully implanted in the lining of the uterus. Folklore notwithstanding, miscarriages aren't brought on by irresponsible eating or drinking, overly enthusiastic sex, excessive physical exertion or emotional stress. I understood all of this, lying there in the dark. But as waves of cramps gripped my hips like a wide, tight belt, I couldn't help feeling the failure was entirely mine.
I had loved so fiercely the physicality of my first pregnancy: the glowing skin, the full breasts and the high, hard dome of my belly. I had taken such pleasure in the fluttery internal stirrings, had basked in the nurses' concerned questions and overtly enjoyed the attentions of my handsome obstetrician. In my impatience to regain the privileges of pregnancy, I had rushed into this one, then felt smug about my own fertility. In my hubris, I had unwittingly attracted the evil eye.
Back in the bathroom a few hours later, something solid slid into my hand. Red as raw liver and as large as my palm, it gave like a sponge when I gingerly poked it with my fingernail. It had an unmistakable warmth and a real, if slight, weight. This is mine, I thought, staring. This came out of me. I felt depleted. I have to save this thing, I thought, vaguely remembering something I'd heard somewhere. I have to pack it up and take it with us.
I tried to think where I could keep it. In the refrigerator, as if it were leftover lunch? It was 3 or 4 in the morning, all our plastic wrap and extra food containers were packed, and I was exhausted. And anyway, what was the point? The new life I had imagined growing inside me was simply, irrevocably, gone. I dropped the thing in the toilet and flushed.
Saturday morning we drove to Santa Monica as planned. Our friends Robin and Tony would be giving us breakfast and taking care of Sophie during the move. I carried myself carefully, feeling fragile. Emotionally, I wasn't sure how I felt. Mostly, I didn't want to think about what had happened, much less discuss it.
In the house where I grew up, we weren't keen on confessions. We didn't run around telling each other "I love you" or sit up late at night sharing our innermost feelings. We were more reticent when it came to bad news, especially when it was medical, and all the more so if it involved reproduction. Add death to the mix and the topic took on a strict don't-ask-don't-tell taboo. We didn't talk, for example, about my father's older brother Ralph, who died of spinal meningitis when he was 9. To help my grandmother get over her grief, her doctor suggested she have another baby. The product of that prescription was my father.
I only remember hearing this crucial bit of family history mentioned once while I was growing up. My mother and I were folding laundry when she whispered the bare bones of the story. Assuming from her hushed tones that the tale was meant to be our secret, I didn't dare ask any follow-up questions or wonder about the need to keep quiet.
The story of Ralph was one of my earliest inklings that bad things didn't just happen to strangers. It also impressed upon me the troubling implication that nothing I took for granted -- not even my own family -- was inevitable. Had it not been for the death of a child, we never would have existed. Even if I read it wrong, my mother's whisper reinforced what I already understood: The less said about things that disturbed you the better. What you don't name is less likely to hurt you.
That lesson was still with me the morning after my miscarriage as I silently rode beside David, each block bringing me closer to the time when I would have to reveal to our friends what had happened, and then call my doctor. Actually talking about it would make my miscarriage official. It would turn my private upset into a public event. And it would force me to face the fact myself.
But it was a battle I was bound to lose, and it was over before we even reached Robin and Tony's. As we pulled up at a light, David handed me a pink Hallmark envelope. I had forgotten all about Valentine's Day. "From Sophie," he claimed. The card was classic -- plastic overlay, soft-focus roses, red velveteen. Any other year, such over-the-top kitsch would have simply delighted me. Today, when I read the maudlin message printed inside -- It takes someone special to be a mother -- I was surprised to find myself crying.
When I delivered my news to Robin, the intensity of her teary-eyed embrace also caught me off guard. My own reaction felt closer to guilt than grief. Should I have been more worked up? Maybe, I irrationally conjectured, I had lost the baby because I hadn't been sufficiently attached to it emotionally. Maybe I'd been so enraptured with my own pregnant self that I'd failed to focus on the fetus.
Suffused with self-doubt, I dialed my doctor's office, only to discover that my regular OB -- the handsome Dr. Parker, whose assured, patrician manner I'd counted on -- was off duty. The intruding, on-call Dr. Rosenman asked questions that I heard as accusations. Yes, there was cramping, I confessed. Yes, lots of clots. Yes, tissue. No, I didn't keep it. I flushed it down the toilet. "It was really gross," I added, feeling defensive. "I see," she said with sigh.
An hour later, perched at the end of the examining table, I calmed myself by taking inventory of my surroundings. Stirrups, sink, spotlight. Surgical gloves, lubricant gel, sponges, forceps. There was something soothing about simply listing nouns. By the time the young technician came in with her tourniquet and vials, I was considerably less freaked out. As she drew my blood, she asked how I was doing. "I had my first baby here," I told her. "I didn't think I'd be back so soon with this one."
"It happens more often than you'd think," she replied. "After you've been hanging around in hospitals for a while, you start to get really impressed that so many babies come out just fine."
Dr. Rosenman was wearing jeans and a sweatshirt, looking more like a college student than an actual M.D. She didn't pick up her clipboard or check her watch, but rolled up the low stool, crossed an ankle over her knee, and invited me to tell my story. It may have been her relaxed, disarming demeanor, or the fact that I'd only just met her. Or maybe by now I was simply ready. Whatever the reason, I told her everything -- right down to the wadded toilet paper and the one emergency sanitary pad in my purse. When I was finally done, she whistled. "All this trouble while you're supposed to be moving! What a pisser!"
Courtly Dr. Parker would never have said that. And when it came time for the physical examination, her touch was also nothing like his. He handled me delicately, as if my body were something exotic and rare. When I was scrunched down on the table with my knees wide and Dr. Parker on the other side of the paper drape, I thought of him as some high priest of healing and the procedure as a sort of sacrament. With Dr. Rosenman, the experience seemed much less mysterious and more down-to-earth. Her hands moved with confidence and vigor, like one flesh-and-blood human being simply caring for another.
"Could we have saved it if I'd been able to call you?" I asked afterwards. She shrugged. "I might have told you to come in. Then you could have done your bleeding here, instead of in your own bed. But basically, it wouldn't have made a hell of a lot of difference."
"Was I really stupid not to save that piece of stuff?" I wondered. Examining the actual product of a miscarriage helps doctors figure out why it happened. But she batted away my question. "Plenty of women never get a hold of any tissue, and yet we somehow manage to bumble through with our work. I wouldn't worry about it."
"On the phone, I thought you sounded disappointed," I admitted. "Disappointed?" she shot back. "You try getting woken up first thing Saturday morning to the news that a patient has probably lost her baby and see if you don't sound disappointed."
All things considered, I got off relatively easily. I had a kind and competent doctor and a health plan that paid for her services. I didn't need a D&C -- dilation and curettage -- to clean out left-over remnants of the pregnancy. I didn't have any problems with prolonged bleeding or infection. It wasn't long before I stopped feeling blue. Best of all, within a few months I got pregnant again, and delivered a healthy son -- a child I can't imagine living without. Like my father, Sam never would have been born if another child had survived.
I hardly ever think about the fact that I once lost a baby. When I do, I don't feel sad. Rather, it reminds me that these lives we tend to take as our due owe as much to lucky breaks as to our careful plans. Instead of scaring me, as it once did, this realization takes me back to that Valentine's Day when I left Dr. Rosenman and Robin dropped me off at our new place.
David and the movers were already carrying in our things. Downstairs, our neighbor was celebrating a birthday. Girls in frilly dresses were playing on the grass and a bouquet of translucent and Mylar balloons bobbed by the door as if they were welcoming me home. Though I knew those balloons weren't meant for me, the scene looked so pretty I started to cry again. For that brief moment, I felt very fortunate just to be alive, enjoying the play of the sun on the silver and pink.