King Duncan Had Less Than I Did, I Assure You

Your Auntie Ann has some advice for you: do not, under any circumstances whatsoever, get yourself born with two uteri, medicate yourself with drugs to markedly increase the plump vascularity of your endometrium for 5 long weeks, and then eject the lot in a 16-hour bleedathon.

You will end up in hospital on IV fluids with a blood pressure of approximately Bugger over Fuck. 

I had what the older generation would classify as a ‘funny turn’ on Wednesday evening which continued until, on Thursday morning, I suddenly and painlessly lost what I then thought to be a significant number of large clots. (Ah, naive child! Such inexperience!)

The absence of any real cramping had caught me on the hop, and I thought we’d left it too late to reach hospital. There followed the most horrendous 30+ mile journey in rush-hour traffic, and, as my head was still in the funny-turn-fall-over stage, the profound and ultimate sinless public shame of being carted through the thronged main doors at 9.30am in a wheelchair, with bed hair. What expression are you supposed to adopt, for crying out loud? Stoic? Pained? Helpless? In retrospect, I should have simply feigned unconsciousness, slumped artistically, and welded my eyes firmly shut against the indignity.

Naturally, as soon as I arrived on the ward, uterine action ceased, and it was only after much to-ing and fro-ing, and – despite the Prof’s detailed but illegible notes – having, as usual, to work my explaining way up the ranks (No, you cannot send me to theatre. No, you are indeed unable to visualise that cervix. Yes, I have done this before.) that we agreed that trekking home again with a half-open cervix wasn’t an option compatible with cytogenetics (Yes, I am clearly written up for fetal karyotyping. No, I do not need to justify this decision to a Registrar. Go and ring my Professor.) and that I may as well start misoprostol a day sooner than planned. By the time the ward bed-block resolved and I moved into a room of my own, it was early afternoon, and I’d sent John home (it was, unamusingly, his 39th birthday; watching bleeding wives is not quite his metier plus Harry needed collecting) and settled down with my book for the long haul.

I did very well with the misoprostol, all things being considered. I hung onto the loading dose of 4 dissolvable tablets for approximately half an hour, before brisk southbound vaginal traffic bulldozed them back out, intact, into one of a long series of horrifyingly weighty bedpans, where the sight of them caused me a moment’s perplexed What The Hell? That 30 minutes, however, was just enough to nudge things along very gently, and by the time the second dose fell due at 4pm, I knew the sac was imminent and wouldn’t take it.

There was puzzlingly, weirdly little pain, from start to finish, and at absolutely no point did I need pain relief, although I eventually accepted some paracetamol simply to keep my nurse quiet about it for the next 4 hours. There was mild dismay from the staff regarding the sheer unbelievable quantity of… output. The veteran of two previous losses – with a double uterus, moreover – at about this gestation, I was initially fairly sanguine, but even I began to stare in increasing consternation as it just kept. on. coming. Agitated, I began to feverishly review my knowledge of Basic Anatomy, and even allowing for my distinguishing deviation from it, could not work out how several quarts-worth of endometrial wall could be so busily decanting from two little pint pots, especially as only one of them even felt active. I vaguely wondered if it was time to look for higher ground.

Of course, there is only so much of this sort of thing that a body can take before Exhibiting Complaint, and by dinner time I was towing a wheeled IV stand on my frequent staggers to the bathroom. By bedtime I was clutching it as a walking aid. By the time my uterus decided that it was, broadly speaking, finished, I was darkly cursing the drip fluids that kept relentlessly filling my bladder and driving me out of bed. By 1am, I was exhausted enough to drift off for a couple of hours – no thanks to the usual hospital clatter and clamour and the dear lady across the hall who snored like a jet engine being tested to destruct, but probably some thanks to rubbish blood pressure.  

Anyhoo. By the time breakfast rolled around, I felt a lot better, bleeding had slowed dramatically, and after short commons the previous day, I fell on breakfast and demolished it. I was keen to ensure that correct cytogenetics paperwork had been completed, and, that done, depart. Fat chance: everyone had the immortal rind to be stupidly busy. By 11am, I hadn’t seen a medical soul since 6am except for the phlebotomist (I have no idea why they still wanted full blood counts at that point, and neither had she when I enquired, but I held an arm out unbegrudgingly nevertheless.) so I removed my own IV and started politely agitating at the desk – neither action quite endeared me to Sister.

Eventually I recruited a delightful young SHO who cheerfully grappled with the cytogenetics paperwork – evidently not something anyone was familiar with – and tried his best to calm my worries that after 20 hours in the fridge already, Turbo’d be useless by the time the pot arrived anywhere.

I was finally sprung at lunchtime. I came home. I slept. Nagging nausea is still an issue, but I feel nearly human again – or did, until I saw the news, which upset me back at the time.

In terms of where we go from here, I honestly don’t know. We haven’t discussed it, although I have booked an IVF follow up appointment with the Consultant who had the titanic struggle with my transfer. The Prof (primarily an obstetrician) said she was happy to manage scans of any future pregnancy but was, bizarrely, ‘too depressed’ by events to discuss the actual way ahead – if there still is one for us. After consultation with Transfer King Consultant over management of miscarriage, she brought back a message that he was devastated to learn our news, but was still very upbeat about the future. Given that A) he is an absolutely delightful chap, B) he doesn’t seem to want to give up on me, C) he is the only senior consultant in the unit I haven’t yet seen, and D) he was so spectacularly nice to Harry when they met: we’ll go see him in a few weeks.

Life is full. But I feel, in every possible sense, very empty.

There Is A Limit

to how much I can cope with, and I have just reached it.

Miscarrying for the 5th time, I can just about manage.

My MIL twisting the knife, I can nearly put up with.

The fox eating all Harry’s hens, I can live with.

My Professor now viewing me as a hopeless case and referring me back to someone else, I can stand.

I have, after all, been most kindly supported by everyone else.

But I’m not sure I can sustain the further intense disappointment I have just been hit with, namely that the lab did not, in fact, freeze our other blastocyst. We have nothing, now. The letter that should have been sent out to us immediately after transfer explaining what happened, wasn’t.

They are very sorry, apparently.

I didn’t feel beaten this morning. Hurt, wounded, wretched, yes, but not beaten or despairing. I thought we had something left still to show for all the trouble, hassle, and financial wipeout.

No. Now: I feel really bloody destroyed.

I have, I know, felt worse than this in the past. Miscarriage pre-Harry was a bleaker existence than miscarriage post-Harry. I didn’t have the fabulousness of the interwebs back then, either.

Today, however: I do feel trampled hard into the floor. 

I still haven’t bled, although I can feel the mifepristone they gave me this morning doing something vague; I’m going back into hospital on Friday for the big misoprostol guns if nothing occurs before then.

Once more unto the breach, dear friends… close the wall up with our English dead.

HenryV Act 3 Scene 1

Peripeteia

Turbo’s heart stopped in the early hours of Saturday.

I’ve known since Saturday morning. I didn’t post before today, because I didn’t think I could quite cope with the likely reaction following a flat statement that I knew this pregnancy was over when I couldn’t find a heartbeat with a foetal doppler at 8 weeks + 5 days. I didn’t want gentle admonishment about doppler reliability, and I didn’t want hope kindly prodded my way – simply because I knew there wasn’t any.

Once I’d finally figured out where the heartbeat was located, on Friday, it was entirely straightforward to find again – I am nothing if not an old hand with this doppler – and I listened in again, briefly, before bed, on a normal-sounding 175 bpm foetus. On Saturday morning, following a night of evil dreams, dopplering was like scouring the empty ocean. I spent hours – pitiful, trembling, weeping, increasingly panic-stricken hours – listening, searching in vain. By Saturday evening I’d accepted my findings, and stopped looking altogether.

On Sunday, I simply hoped that nothing would kick off until I’d had a chance to see the Prof this afternoon, and at least have an opportunity to discuss if there was anything we could learn from tests. There’s not a fat lot of karotyping you can do with a foetus that has disappeared into your septic tank, plus I had a selfish notion that I would rather like to be asleep and oblivious for this one. I’ve been awake, dilating, and sadly analgesic-free during expulsion of 7 and 8 week pregnancies before, and I anticipate absolutely nothing pleasant or painless about the propect of losing a nearly 9-weeker whatsoever.

My wishes are not, however – and as usual – going to be gratified. My distraught and ‘really depressed about this’ (!) Professor left clinic to talk to the Consultant who had the struggle of his career inserting the embryo transfer catheter through my S-shaped cervix, and they have both come back with an apologetic but decided negative. I am simply the wrong shape for a medical evac, and they dare not attempt it unless in uttermost end of need and I am about to cark it. I have spent an hour sat listening whilst my Prof filled in elaborate ‘Do Not Dare Take This Woman To Theatre Unless You Are The Night Shift Consultant Obstetrician Who Has Read Her Entire Set Of Notes, Spoken To Dr X, Failed To Keep Her Stable On A Drip, And Has An Ultrasound Machine To Guide His Every Move’ -type paperwork, and has sent it over to Gynae A&E. 

She gloomily predicted that I might be getting on with things myself fairly soon: I have an ‘enormous’ clot sat right over my cervix. I have requisitioned bedpans and a suitable lab pot for the pregnancy sac – she agreed that karotyping would be worth a try – in case I am caught embarrassingly short of the ward. Judging exactly when to make the 30+ mile dash to hospital is a decision I fear I will get wrong, and sure as God made little apples: it’ll be in the dead of the night.

To my gall, I will have to summon my MIL, who lives very close, to look after Harry if so. I am not quite sure what entitles her to make free with information that most certainly is not her own – apart, that is, from a lifetime’s industrious practice at breathtaking impertinence – but she has just informed us, upon hearing our news, that she has, today, told Harry’s nursery staff (the ones I am theoretically scheduled to meet and bollock on Wednesday) that I was pregnant, but that it was early days, and we’d had ‘lots of problems’ before. They all then had a lovely conversation about how Harry is evidently picking up vibes from the situation. (He isn’t.)

I have told John that I am confident he will take an early opportunity to invite her to apologise for her invasion of my privacy, which is dialogue he won’t enjoy. The poor man (who did not really buy into my doppler findings, and so has had a particularly bad afternoon) was even attempting to defend her empathy skills as we drove into the yard to collect Harry, after I grimly announced that I might as well come and hear her inevitable reverse-bon mot in person. I am sure I have mentioned here before that this is the woman who coolly informed me, after miscarriage number 3, pre-Harry, that John would be ‘so disappointed if you don’t have any little ones’. There are many just retributions in this life that I deserve: John’s mother is not one of them; although, who knows? Perhaps ousting grief with anger might even be vaguely beneficial to my emotions, although, assuredly, not to my blood pressure.

I had bloods done before I left, just in case everything goes about as wrong as it can go, and I attempt to bleed out. If nothing happens this side of Wednesday, I am to go back in for mifepristone, and back in again on Friday, when everyone senior is floating about, for misoprostol. Misoprostol is an absolute fucker that hurts like blazes, so I have ensured I am also written up for vast quantities of pethidine, a drug I previously availed myself of far too late in the proceedings for comfort. I don’t think this’ll run as far as Friday, but we’ll see.

And… I can’t think of much else to say. By yesterday, my uterus felt entirely different, and the cramping I have experienced since the off had subtly changed in nature.  The nausea and crippling exhaustion have, now, begun to recede a good deal. I think I would have guessed by this afternoon, even without the doppler; I’m glad, in any event, I didn’t have to endure the shock of a unexpectedly bad scan, and silent medical personnel. Today, I knew before they looked, although the ‘I’m afraid I think you’re right’ still wasn’t easy.

I did so, so want to be wrong.

Thank you for all the hand-holding. It does help, I promise.

Metaphorically, I Look Like A Fat, Drowned Chihuahua

Still here. Still haven’t changed the duvet cover. Still twinging. Still sicky. Still stressed.

But, on the bright side, the bleeding is darkening and tailing off; the pain isn’t getting any worse, at least, and John is turning out to be surprisingly domestically adept when he is given no choice. He’d even washed and dried Harry’s school uniform since Tuesday ready for his afternoon nursery session today, which made me narrow my eyes a little in thoughtful contemplation of future division of household labour.

I believe I mentioned something rash about going for another scan today; I have no better news than failure to bring you. I spoke to a markedly less sympathetic nurse on the phone who, after eliciting that I was not doubled over in agony or standing in a bloody puddle, told me that I would do better to come in for a viability prognosis after the bleeding had stopped altogether. When I politely demurred, she told me flatly that they had no appointments – this is a gynae A & E – until next week.

It is my usual practice, when thwarted by the NHS, to instantly, and with complete absence of any type of qualm, throw money at the private sector. I rang my local private ultrasound clinic, only to discover that they do not work on Fridays. Bugger. The only remaining option would be to drive many miles to another clinic, a much more expensive one, in a location I don’t know, alone, when I am supposed to be sitting down doing nothing. The risks didn’t seem to outweigh the benefits, quite, so I am sat here calculating just how many hours of weekend I have to get through until 3pm on Monday.

Not, of course, that Turbo’s continued survival at that point will mean a great deal in terms of prognosis. Julie will perhaps correct me if my memory is adrift here, but I remember reading some years ago, somewhere in the depths of her wondrous archives, that her husband Paul had once spoken words to the effect that: even the most reassuring scan can only ever tell you what has happened. Past tense. How true. Because, of course, I am now simply sitting here under the suspended sword of Damocles, waiting – and shall continue to wait for the entire undetermined length of this pregnancy – for the next crucifying haemorrhage, for the sharp, harbingering cramps.

It’s a shit of way to spend a few days. Weeks. Months, if we’re lucky.

I knew this was a strong possibility when we embarked on this cycle, but a little part of me was stupidly, illogically optimistic, and was clinging fast to the unquenchable, refulgent spark of the It’ll Be Alright This Time hope. I have been thoroughly fire-extinguished, and am sat sodden, shivering, deflated and depressed  – and in a stinking bad mood to boot – in the spreading puddle of my hopes for Uncomplicated and Straightforward. I don’t think my fur is ever going to look the same after this.

*** Updated to add***

In a return to my previous Champion Doppling form, I have just picked up 8+4 weeks Turbo on my doppler, chugging away determinedly at 175 bpm still. Probably IS wearing a tin hat.

Siege

Well, I have taken to my bed. Thankfully, I had changed the sheet not 24 hours beforehand, but the pillow cases and duvet cover are… of older vintage, and a whole day of spilled drinks and melting snacks haven’t improved the general festeringness. It’s looking like that thing of Tracey Emin’s. I will have to ask for John’s help later to change the cover: it is a superking monster, a two-man job, and I always feel that the task would be ideally suited to a trained set of C18th sailors, with masts, spars and rigging available. A great deal of arm agitation seems necessary to settle the new cover into place; unfortunate, as the change is inevitably undertaken at bedtime, when John’s domestic fires burn at their absolute lowest. He has a tendency to lacklustrely poke his side vaguely inside the cover, dive swiftly under the resulting lump, and lie there looking smug, while I fuss over my own, compromised-by-lump, side, like a cross hen.

I digress.

The bleeding, although still very red with the odd small clot, has been tailing off this afternoon, and could no longer be classed as heavy – at least, not by didelphic, menorrhagic me. The pain, however, is becoming a little worse, which leads me to suspect that there is still active bleeding taking place in there. I am rather worried that it is quietly building up behind my cervix to stage a repeat of yesterday morning, and emerge in half-pint quantity all of a sudden. It really was so alarmingly sudden and… haemorrhagey. I am extremely worried, of course, that the pain indicates that the area of bleeding is extending northwards, and is currently dislodging Turbo, hanging on for grim life in there.  

After doing battle with the never-answered telephone system at my clinic, I finally lost patience, rang the nurse helpline, and bleated to a Real Person, even a friendly and useful one. She intercepted my (since-superceded-by-holidaying-Professor) Consultant mid-corridor, related my woes and current distrust of heparin, and brought back a message endorsing temporary discontinuance of them. Recommence upon cessation of bleeding was her advice, although I think I will wait until Monday, regardless, when I have an appointment with my Prof. (The two-week appointment referred to in previous post was simply to ensure I have weekly scans booked for the time being.)  Still, even Monday seems like a long way off currently, what with the whole increasing-pain-and-copious-blood thing, so even if I have nothing sinister to report, I shall go back for a check on Friday.

Thank you, most sincerely, for your support, handholding, and skillful application of duct tape. It is very greatly appreciated and consoling, because I am miserable. If I am to actually miscarry, I would greatly prefer to do so before Turbo starts looking distinctly humanoid, which will be soon. I would like, if I cannot have another living child, a rapid, merciful close for both the foetus and us. To have Turbo cling on bravely in the face of a hostile environment – and the fault here seems blatantly not that of Turbo, who has been textbook perfection since fertilisation – and then lose the battle with the uterine elements further on down the line, would be torment added to distress. Do Not Want, etc. I am desperately hoping for a better outcome than my current discomfort tells me is likely here.

Still. I have books. I have internet. I have highly unusual amounts of peace and quiet (only excepting my wretched, moronic geese, who are making my supposed rest a honking travesty, and, given that my temper is currently lethally short, risking imminent transmogrification into a large pot of goose fat).

So. Mustn’t grumble!

Bed Rest

at the ripe old gestation of 8 weeks, prescribed on the basis that the fat lady has not yet definitively sung. The area of endometrium that has, for reasons known only to itself, decided to fall off and haemorrhage badly (heparin and aspirin are not helping the oh-dear-God-so-much-blood situation) is situated below Turbo and not above. Turbo is still there, still struggling bravely to stay alive – albeit mysteriously shrunk 1.5mm overnight – and probably eyeing the immediately-adjacent-to-gestational-sac source of the bloody torrent with well-founded apprehension.

It would be unlike me to get things over with in a mere 24 hours; that is not usually how I fail at pregnancy. Not for me, the swift clean ending. I fear I must trespass on your spectacularly kind limb-holding a trifle longer. Little Turbo’s demise, if demise there be (and oh, how I am miserably expecting to let you down, Turbo. I am powerless to rescue you from this lethally faulty housing I have hopefully, naively, installed you in. How did I ever think I might avoid disaster this time?) will likely be a protracted affair.

I have, of course, been told to go straight back if the pain or bleeding gets worse, but my biggest immediate fear is miscarrying without warning at home, and having to take pregnancy sac – assuming I manage to save it from a watery and ignominious toilet grave – back to hospital for tests. Which has happened before.

Poor Turbo. Poor John. Poor Me.

And It Gets Worse

The spotting stopped fairly quickly. Unfortunately, it was succeeded this morning by a sudden, heavy, haemorrhaging bleed with clots that instantly soaked an entire pad.

This is what you get for starting to hope.

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