Monday, 1 December 2014

Don't Start Believin'

It was the best of times, it was the worst of times, 
It was the age of wisdom, it was the age of foolishness,
It was the epoch of belief, it was the epoch of incredulity,
It was the season of light, it was the season of darkness,
It was the Spring of hope, it was the Winter of despair...
-Charles Dickens 'A Tale of Two Cities'

I've become convinced that Charles Dickens was describing the practice of obstetrics and not the political unrest in France and England during the late 1700s, when he wrote those words. I hate to admit it, but I start to get nervous when I see too many happy new OB visits, as I know that streak will be broken by a lurking non-viable pregnancy. What's worse, is that it always seem to come in threes.

New Girl acknowledged that she understood why we would still feel cautious, so she offered to be happy and excited for us. She went ahead and calculated our due date. It is in the middle of July. It is also the same birth day as Myrtle's older brother. Myrtle's brother is a total dick. There are several stories I could share to illustrate this point, but the most salient one is that in the mid 90s, he had a one night stand with a girl who went to high school with me and Myrtle. She was two grades ahead of us, but she was in our Algebra class. A baby resulted from that lone encounter, and a court ordered paternity test confirmed Myrtle's brother was the father. When he told Myrtle, he confessed 'we used a condom, but it broke...' Myrtle replied with the best line of her lifetime "That story may work on our parents, but there was no condom. I've seen you in the shower, you're not that big!"

He had child support payments garnished from his wages, but he never once even met his daughter, who is now nineteen years old. Myrtle's parents never told my parents and they have never acknowledged their granddaughter. It's a huge family secret. Myrtle and I ran into the mother about twelve years ago, and Myrtle decided to go over and talk with her. She had just wed her long term boyfriend and he was in the process of formally adopting her daughter. Myrtle's brother was only too willing to officially renounce his parental rights and was delighted that he no longer had to provide child support. She also described that her daughter really enjoys art and is quite talented -a skill inherited from her paternal grandmother, who is an artist. Fortunately, only 5% of women deliver on the assigned due date and it's likely that I'll be induced a week early due to my blood pressure issues. Actually I'll be very fortunate if I can make it to 39 weeks.

As I admit that I'm getting way ahead of myself, Husband and I also took the liberty to discuss how we might tell my parents. We both were considering the same concept, so we just need to agree on the final details. Although I wanted to take a one step at a time approach, out of consideration for optimal scheduling, I arranged my first OB visit and my NT scan. Co-worker offered that she would cancel for me if such a need would occur.

When I came into work the day after my first scan, one of my colleagues received a call from a radiologist. Her patient started bleeding the previous night, so the after-hours advice nurse arranged her to have an ultrasound first thing in the morning. She should have been 11 weeks and 5 days, but was only measuring 9 weeks and 1 day and no cardiac activity was seen. I recognised the name. I had just informed her that her early glucose testing was negative. Diabetes was the least of her issues.

I looked at my own schedule. My first patient was a couple who miscarried at 8 weeks earlier this summer, but conceived with her next cycle. I saw her at 6 weeks and again at 8 and everything looked perfect. Today was actually her originally scheduled New OB visit, which included her education session with our LVN. We chatted about her symptoms as I prepped the probe and I almost asked if they were planing to announce the pregnancy to their family at Thanksgiving, but for some reason, I held back. Once again, her scan looked perfect, except for one detail. The fetus was actually measuring a day ahead, but there was no cardiac activity detected. I find it is more traumatic for the patient to hear the futile attempts to auscultate a heart rate, so I use the colour flow application. Although as this patient is also a Nurse, so she knew what it meant to see red and blue flashes everywhere but on the baby.

Later that morning I had another patient coming in for a viability follow up. She was 41 and this was a surprise conception. I remember my RE once shared, "the statistic of only having a 5% risk for miscarriage after seeing the heartbeat doesn't apply to women over 40. The risk is probably closer to 50%."  It's an awkward conversation, and I really haven't really perfected it. Although you don't look like you're in your forties, women at this age are still at a higher risk for a miscarriage, so I like to scan my patients more frequently. You may consider waiting to announce your pregnancy until after the first trimester... I suspect that many are just so happy at that moment that they really aren't hearing what I'm saying.

She should have been 9 weeks at 3 days, but she was measuring a full week behind and once again, no flicker of cardiac activity was detected. I began to wonder if there were something broken with our ultrasound. I let patients decide if they want to have a formal scan to confirm. Some find reassurance with a second opinion, others would rather not endure a second procedure that won't affect the outcome. She elected to be scanned by radiology and my findings were confirmed. Although she had the highest risk for miscarriage of the three patients who received the diagnosis that morning, she was the most distraught. No matter how many times I explained that it most likely is due to an age related egg quality issue, she posed another theory. "Is it because I started prenatal vitamins late?" "Is it because I exercised?" There are some things that the mind just doesn't want to hear.

Days like these are really hard and I feel as if I hate my job. It's not too often that I encounter a miscarriage measuring at 9 weeks. I had to think back and the last one I recall was over a year ago. Now I had three within the same morning session! I know these situations pose no influence over the fate of my own pregnancy, but it shook me up a bit. Interestingly, all patients opted to do a chromosomal analysis on their products and my prediction is that at least two will reveal an abnormality. Even with an euploid embryo, I still feel vulnerable. I sent a mass text to all those in the know. All forward thinking and planning ceases with immediate effect. I didn't even bother to scan myself again, for it would only offer temporary reassurance. The message was received. Everything can be taken away from me at a moment's notice. I can't forget that.


  1. Oh, I feel so terrible for your patients and for you. It's hard enough to deal with the anxiety of early pregnancy in the best of circumstances, never mind having to support three people who are received the horrible news that their pregnancies aren't viable. All I can say is your patients are lucky to have someone who understands and can give them the compassion that you can. I also struggled with the knowledge that everything can be taken away. (Still do, sometimes). But after time did not think about it constantly (although you can't un-know something like that.) You will at some point be able to do that forward thinking and planning. Till then - one day at a time.

  2. Oh Jane, I imagine there are a few perks to your job, but a whole crap ton of negative ones when dealing with infertility. It sucks when everyone is blissfully happy and getting pregnant without trying and it sucks when you're reminded day after day that things can change in the blink of an eye. I'm really, really hoping that everything works out for you! It is certainly time for you to have reason to celebrate!

  3. This post broke my heart. I just can't imagine seeing such heartache sometimes. My RE told me today - One breath at a time. It was fitting and I think in times like this, that's all we can do to make it through the tough stuff. Thinking about you always and believe fully that now is your time to celebrate, however cautiously you may choose. XOX

  4. I can't imagine doing what you do! It takes a strong person to do your job and I commend you! Thinking of you always and truly believing that this is YOUR time!

  5. Wow. What a horrible morning, for both you and your patients. I'm so sorry that all of this came at once! I imagine it makes it all the harder to settle into your pregnancy, knowing the risks so first hand.

    I am looking forward to your post about your parents reaction to your announcement! Also, Myrtle's brother really is a dick. Kudos to Myrtle for what she said to him, and also for approaching the mother later on.

  6. I remember thinking as I went to my OB appointments, that it seems to be the only branch of medicine where it's generally good and happy news. Patients aren't coming to you because they are sick but because a new life has been created. But, then it also seemed like because of that, the bad news would be that much more devastating. Infertility aside, it has to be so hard to break that news to the excited, expectant parents. I know I wouldn't be very good at it. Your patients are lucky to have someone so compassionate. I hope in a few weeks you can start to believe and look forward to this actually happening.

  7. Wow, Myrtle's brother sounds like a prize douchebag. I'm surprised her parents haven't been interested in meeting their other grandchild, given how crazy they are about little Myrtlepants. As for your patients, that would be an incredibly hard day for anyone, let alone a newly pregnant infertile. I don't blame you for hating your job that day.

  8. Wow talk about a rough day! As Aramis said, it had to be even harder given your status as a newly pregnant infertile. If I had to hear my pregnancy wasn't viable I'd want to hear it from someone as compassionate as you. Your patients are lucky to have you.

  9. Kudos to you for using the color flow to at least soften the blow. I could never do what you do... and your story above illustrates why. I'm just thankful that there are people strong enough to handle it, and compassionate enough to do so with grace.

  10. Myrtle's brother sounds like quite the douchebag. I never understand families that shun kids/grandkids simply because of the circumstances in which they were born. The kids never did anything and you are missing out on your flesh and blood!

    I'm sorry that you had to give tough, tough news to not one but three patients. I hope that as the weeks tick by you are able to start believing in your pregnancy!

  11. That is a really rough day, and I'm sorry that you have to deal with it. I'm glad your patients had someone so compassionate to break the news to them. I am looking forward to reading how you share with your parents and their reaction.

  12. What a tough morning. I've learned the lesson about everything being taken away at a moment's notice, and that was at 26 weeks. It's heartbreaking but it is life. Just not the side of life you hear much about.

  13. My friend has a similar situation, although he wasn't quite as douchey--her older brother fathered a child in high school, relinquished any claim to the child. A few years ago, my friend's parents ran into the child in the grocery store. It was very difficult for them.

    Your day sounds like the worst Groundhog's Day I've ever heard of. I was holding fast onto that 5% stat after my first ultrasound (even knowing that it was probably higher since we were only 6w2d). Nothing is guaranteed.

  14. I bet you are the best person anyone receiving that bad news could possibly hear it from. I'm glad you try to be sensitive, given your history, and that you try to be delicate whether or not they're listening or not. What a day you had though! I'm sure it's a constant reminder of what can go wrong, but you'd already had your fair share of hardships. I really believe in my heart of hearts that you have nothing to worry about this time, and I am counting down the days until you post about your birth story!