The anesthesiologist spoke with a slow, thick drawl I felt more than I heard. He was tall and sturdy, wide with muscles that flexed when he talked. He was a long way from the Tennessee hills where both our roots were sown, but he seemed right at home next to my hospital bed, laughing thunderously at his own jokes while a nurse threaded IV fluids through a tube to the catheter in my forearm.
“You won’t remember any of what happens next,” he offered. I breathed deeply and let my shoulders relax, grateful for the help. As the surgical team wheeled me back to the operating room, I flashed Randy a peace sign and hollered much louder than I needed to, “See ya later, sexy!” His worried face was the last thing I saw before everything went blank.
Part 1: The Heatwave
Part 2: And Then the Rains Came
Part 3: In the Bleak Midwinter
Part 4: Hail Mary
In early February 2017, our experience of pregnancy after miscarriage was set against the backdrop of a world suddenly in peril. They weren’t related, exactly, but neither could we easily separate one from the other. We marched, boycotted, raged and mourned. We had to be mad and hurt and fired up and present and engaged and impactful while still finding joy and experiencing love – anything to keep the fight alive without burning out. For our little family, keeping the fight alive meant opening our hearts to this pregnancy and loving it deeply, which felt both like a luxury and a necessity. And it actually worked. I was so high those first couple of weeks while we were falling in love all over again, urgently and with purpose, that it felt inconsistent with what everyone around me was feeling. Then again, it also felt kind of on time, because, like, what if this baby is the one who will turn it all around, for all of us? I can still access that high, even now. It was fraught and complicated but real, despite the very recent understanding that it could end.
We had no intention of waiting the usual 11 weeks for our first OB appointment, so I called my doctor’s office to get on their calendar at the earliest time they might be able to detect cardiac activity. They called that visit a viability scan, which was underwhelming.
I trembled with nervous energy as we went through all the same motions as a month before. “No, I haven’t had a cough or cold in the last 24 hours. No, no fever. Yes, same insurance. Same address. Same phone number.” Yes, everything is exactly the same as it was when I was here like five minutes ago, except I was pregnant then, and then I wasn’t, and now I am again. “Yes, same pharmacy.”
The nurse weighed me and took my vitals while Randy answered all her small-talk questions. Last time, I was content to talk about the weather. This time, I didn’t know or care what weather even was. Does the weather turn on the ultrasound machine and detect a beautiful, healthy heartbeat and breathe a huge sigh of relief? No it does not, so let’s do that instead.
I looked hopefully at the screen, like déjà vu, while Randy stared at the floor, then at me, then finally, reluctantly, at the screen. The image flickered. We squinted, trying to make out anything that might turn into a baby, and there was… something. Not a heartbeat, exactly, but enough cells they were able to estimate I was about six weeks pregnant. Our doctor admitted they do often see a cardiac flutter at that stage but not always. I have some vague recollection of her assuring us it could still develop, but then she put the ultrasound wand away and while I was still vulnerable and exposed, she placed her hand gently on my shoulder. She was quiet and not particularly encouraging.
“I’d like you to come back in about 10 days so we can check again,” she said. “We need more time to know for sure.”
That’s when time became a character in our story. A villain that choked us with its merciless, suffocating chronology. It was 14 days between our positive pregnancy test and our viability scan, the happiest days of this pregnancy. It was 10 days between that inconclusive viability scan and our next prenatal consult; those days were quite a bit dimmer. I would be lying if I said they were the saddest days of this pregnancy, because we forced ourselves to maintain some optimism, even if only because we felt like it should be improbable lightning would strike us twice. We didn’t have a lot of reason to think good thoughts, but we asked ourselves, why not choose hope? After those 10 days, though, our next prenatal consult visit nipped that unearned hope right in the bud.
“We see a heartbeat, but it’s slower than we like.”
It was one hour between our last prenatal consult and our first perinatal ultrasound. By this time, I was eight weeks pregnant. The fetal heart rate for a pregnancy at that stage should have been between 149 and 172 beats per minute. Ours was 70. Seventy was not great, but it was also not nothing. The perinatal ultrasound room was dark, even after the exam over. It felt too hot and somehow also too cold. We sat there uncomfortably, contemplating our options. What do you do when it’s not great, but not nothing?
“Come back in a week; we need more time to know for sure.”
It was seven days between our first perinatal ultrasound and our last perinatal ultrasound. The odds were not in our favor, and as Randy recalls it, the doctors already knew our pregnancy was over, but they gave us the space to come to that on our own, which was, of course, excruciating. It would have been better if it was nothing, no heartbeat, like last time. Instead, we were in painful limbo, which prolonged our grief and stopped the clock on our ability to move on.
When that week was up, the maternal-fetal medicine specialist sat with us in the same dark room as before and read the results of our ultrasound, quietly. Everything was always so quiet. I wanted to vomit and throw things and scream into the void, but there we sat, speaking in hushed tones, silence filling every inch of available space.
“You are going to have a baby again,” she said, holding constant and kind eye contact with me while Randy stroked my hair. “It’s just not going to be this one.” The tenderness of her confidence became my guiding light, the only thing that kept me from standing still while that evil villain time marched on.
It was 48 hours between our last ultrasound and our second dilation and curettage. This time the medication did not take the edge off. I was angry and tense. And deeply sad. It hurt more, both physically and emotionally, and I wept, trying to block out the harsh light and whir of the machines.
Thirty-four days from start to finish.
In the weeks that followed, I would catch myself playing this game where I evaluated one pregnancy failure against the other, grading them on an arbitrary scale of badness, as if one was more or less terrible than the other. But they were both awful. I stopped digging deep for silver linings, and I stopped pretending I was OK. Giving myself over fully to the grief felt like the right thing to do, like, the only way through it is through it, and surely this is the bottom. But of course, it wasn’t.
Sometime during that recovery period, I was asked to go back to the lab. Pathology had determined the fetal tissue from our failed pregnancy had a fatal chromosomal abnormality, but there was also some concern my thyroid level was still too high to support a healthy pregnancy, so before we proceeded with next steps, that would need to be managed. I felt like the state of my guts was already pretty meticulously documented, but I went to the lab anyway like a dutiful, compliant patient. The next morning, a nurse called with my results.
“Your beta HCG levels are elevated….?” It was more a question than a statement, and her voice trailed off like, listen, I don’t know what the hell is happening any more than you do, but you’re pregnant again, and do you know what causes that, and did you know it’s not in the water, and maybe you should lay off the together time for a while, and we’re going to need you to come in for an ultrasound, and what kind of wine are y’all drinking. I imagine that’s what she was thinking anyway.
I was immediately thrilled, despite having no real reason to be since pregnancy wasn’t something that had brought us a lot of joy lately. Nevertheless, I was electrified. Thanks a lot, human condition. We had exactly four hours to get used to the idea of yet another new pregnancy before I began to hemorrhage, and that’s when things got really confusing. I went back to the lab the next day. Pregnancy hormone was still elevated. Then I had more painful, heavy bleeding. Off to the lab I went. Pregnancy hormone… elevated.
Like, what?
By the time I made it into the advanced imaging office for an ultrasound, I had stopped thinking good thoughts. Or bad thoughts, for that matter. I thought no thoughts. After an ultrasound where neither Randy nor I looked at the screen a single time, the maternal-fetal medicine specialist sat with us, translating medical jargon into lay talk. The quiet had returned to this familiar room, but this time, in this season of thinking no thoughts, I didn’t care.
“You’ve had a spontaneous reattachment of fetal cells, which are now growing unassisted by a viable fetus, and they are attacking your uterine wall, invading it and spreading like cancer.”
Cancerous fetal tissue decimating my reproductive organs. That was the bottom.
A bright spotlight of late spring sun poured in through giant picture windows and reflected off my surgeon’s wedding ring, bouncing a thousand rainbows around the white walls of my hospital room. A sign, maybe. Randy helped me out of the hospital gown and back into my clothes while she talked.
“It was a very organized mass, but we were able to remove it in its entirety,” she said warmly, confidently. Then she added, “The only way from here is up.” All my experiences told me not to believe her, but I did anyway.
Randy wrapped his arm around my lower back while I steadied myself against the bed, and we held that position for a while, lingering in the love that got us here, for better or for worse, in sickness and in health. It was strange to feel gratitude again — in a hospital room, not pregnant — but there we were, finally liberated from the albatross of unrelenting loss, and that sure was something.
julie nattis 
I love you very much.
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