Chez Perky

Officially not pregnant

As of last Thursday, I am officially "not pregnant" at long last. My beta was negative, which means the clock starts ticking on when I can start a new cycle.

That is all the interesting news there is. Never thought I'd be so happy to get a negative beta.

Balancing Priorities

An interesting opportunity may be coming my way, but it will require some sacrifice on my part. I'm taking some time to weigh my priorities to figure out what to do. The short story is that I may have an opportunity to particpate in a migraine study that looks to be extraordinarily promising. The sacrifice is that I'd have to not get pregnant for a year (nor even attempt to get pregnant).

Some background:
I've been getting migraines since I was about two years old. We didn't know then that they were migraines, but looking back, my first neurologist figured that my first migraines were in my toddler years based on the history my mother gave her. Migraines suck. If you've never had one, I'm not sure I can describe it to you, but they seriously suck. I have had so many migraines with such intense severity that my entire pain scale is skewed. I don't even have a real sense of what level of pain I'm in most of the time now, because pain is a pretty constant state in my life.

I've taken probably 3 dozen different preventive medications with varying results. None of them work quite well enough, some of them work better than others. All of them have pretty big drawbacks when it comes to side effects. Topomax made me lose feeling in my hands and I burnt myself fairly badly as a result, but it worked really well. Depakote came with about a 60 pound weight gain over the years that I took it, but it took the number of migraines I got per month down by probably 60%. Inderal helped but threw me into the only true depression I've ever experienced. The depression was completely alleviated after I got off the Inderol. Verapamil didn't help. The list goes on and on and on. I've literally run out of drugs that I can take.

When you run out of preventive options, you start looking at pain relief options. Nothing fully relieves the pain of a migraine for me. I can't take Imitrex nor any of the triptan class medications, which are considered the migraine miracle drugs right now. Aleve takes my pain down from a 9 on the painscale to an 8.5, maybe. Codeine on top of it, particularly if coupled with caffeine, will get me down to maybe a 7.5 or 8. Beyond that, percocet helps, but no doctor will prescribe it to me for chronic pain. In fact, doctors don't really like to treat chronic pain. It's a dangerous area for them. Lots of red flags. Nothing else helps. I think Vioxx did a decent job, but it's off the market.

And that's where I am. I get between 3 and 6 migraines a week if I'm unmedicated. In a good month, I get 10 migraines that month. In a bad month, like last month, I get 25. I am also not exaggerating.

One more Medical Detail:
In 1999, I had the first of several migraines so severe that I lost feeling on my left side for several days. Because there was some concern that this was actually a TIA or stroke, I had a battery of tests done while I was in the hospital for several days. I had two MRIs (both negative for stroke, so it wasn't a stroke), a lot of blood tests, and a TEE (transesophogeal echocardiogram). This is a test where they put a camera down your esophagus (sp?) to take a look at your heart. It is every bit as unpleasant as it sounds and I had a masochistic cardiologist with a preference for having patients be awake during a TEE. (Every doctor I've talked to since has said that's almost unheard of). During the TEE, the cardiologist discovered that I had something called a Patent Foramen Ovale (PFO). A PFO is no big deal; about 1 in 5 adults has it. What it is, is that when you're born there's a flap between the two chambers of your heart called the foramen ovale. Within a few weeks after birth, for most people, that flap closes and the hole is closed along with it. About 20 percent of people DON'T have the foramen ovale close, and it's called a patent foramen ovale. Generally speaking, this causes no problems for most people, though there's a slightly elevated risk of stroke because of it.

How this all ties together:
Several years ago, Seth found a small retrospective study about PFO and migraine. Apparently, there was a surgery that could be done to close the PFO, and this was being done on a trial basis for people who had suffered strokes. Turned out, a bunch of those people reported after the surgery that they'd had a very strange side effect of the surgery: many who had previously suffered from migraines, noticed that their migraines were either gone completely, or had improved considerably. A pattern started to emerge. In one retrospective study about 50 percent of the study participants with PFO who had the surgery had migraines (with aura). Furthermore, the retrospective study showed that of those patients, a significant portion of them noted fewer migraines or reduced severity or even complete resolution of migraines. The initial results looked amazing, but the studies were small and only retrospective. Some larger scale retrospective studies were conducted and the results were even more astounding. Finally a study was conducted to determine whether there really did seem to be a link between migraines and PFOs. This wasn't a treatment study, just an informational one. Turns out, something like 40% of people who suffer from migraines (with aura), have a patent foramen ovale. Seth and I followed the studies very carefully as they came out. I looked for news of full-scale studies with migraines and PFO closure for years. I read everything I could find. I talked to a cardiologist about getting my PFO closed, but he wouldn't do it (no studies had shown this link yet).

Today, three studies are just getting underway, to specifically study the effectiveness of PFO closure on migraines. Several years worth of waiting and research and finally these studies are happening. And I'm literally the perfect patient. I have exactly the right kind of migraines (classic migraines with aura). I have already had a PFO diagnosed. I have had failures with preventive medications. I'm willing to have heart surgery (minor heart surgery, I should specify) on a maybe. I am willing to keep a headache diary for a year.

I have only two possible exclusion criteria from the study. It's possible that I get too many migraines per month, but there's no way to tell just yet. It depends on the month. If in the next month I have fewer than 15 migraine-FREE days, I will not qualify for the study. Some months are better than others. IfI get through this one month qualifying phase, I am fully qualified for the study.

The other problem is that I would have to agree not to get (or try to get) pregnant for a year.

If I went through with the study and do fully qualify, and I get in NOW (as opposed to several months from now), I would not be in the randomized, double-blind, placebo phase of the study. I would definitely get the device to close the hole in my heart. The device costs about $20,000 and is not currently covered under insurance. The preliminary studies are showing such astounding results that it's hard to ignore.

And yet... I have no guarantees about how long it will take me to get pregnant again. I'm not a normal human who can say, "Oh sure, no problem, I'll wait a year and I know I can get pregnant again." In four years of actively trying to conceive, three of which we were actively pursuing increasing amounts of medical intervention in the pursuit to conceive, I had exactly one pregnancy. A pregnancy I was unable to carry to term, for whatever reason. I don't know that next year I'll be just as likely to get pregnant as this year. Nor do I know that if I turn down this opportunity and continue fertility treatments... I don't know that at the end of a year I'll be pregnant. I could be not-pregnant and regretting losing my opportunity to be in this study.

The studies will be going on for years, so I could just wait. Except if I wait, I'd be randomized. Double blind. Placebo. 2/3 get the real device. 1/3 gets the placebo. That means heart surgery for a 1/3 chance of having a placebo. And that means 1/3 chance of having a placebo and then still for a year not being able to change my medications, get pregnant, or try any other treatment for migraines. A year of keeping a headache diary every day without having the benefit of the actual device. Mostly, I'm caught up on the 1/3 chance of placebo, but still having heart surgery. However minor it is, that's pretty huge in my book. But if I went into the study now... I'd be guaranteed the device. The device with such promising preliminary results. The device that could very well show me what life without migraines is like. I have had only very short periods in my life where I was relatively migraine free. But whenever I found a drug that would show me that world... the side effects of the drug would be so intolerable, unbearable, or downright dangerous, that I couldn't continue taking it, and I'd be back to migraines.

Migraines are more than just pain. At least migraines with aura are. My vision goes all wonky. My sense of balance is disturbed. My sense of taste is affected. I get nauseated. It hurts to blink, it hurts to swallow, it hurts to move my eyes. I get blind spots, sometimes for a few minutes, sometimes for hours, always associated with absolutely excrutiating pain.

I know that if I had a guarantee of getting pregnant this year, there'd be no contest. I'll take pregnancy over migraine relief any day. Because when it comes down to it, I've had migraines for almost three decades. I know how to deal with them. I DO deal with them. I function rather well even when I have a migraine, because that's what I have to do. And there is nothing I want more in this world than to be pregnant (and stay that way) and have a baby.

For now, I'm completely torn. I almost hope that I get too many migraines next month to meet the last bit of criteria for the study. But for the moment, what I'm going to do is start the qualifying phase of the study in which I track my migraines with a PDA headache diary for a month. This month I have no fertility-related decisions to make anyway, so it can't hurt. If I do qualify, though, I don't know what the hell I'm going to do.

Migraine Control

I've decided, after having had a migraine every single day this week, without relief from Aleve or Codeine, to call my doctor's office and ask to be put back on Depakote temporarily. My logic is: I cannot take Provera to start a fertility treatment cycle until four weeks after my hCG level bottoms out. Since my hCG level doesn't appear to be interested in bottoming out any time soon, I'm not going to get bloodwork done until 11/10. I actually doubt it's going to have bottomed out by then, but even if it does, the earliest I could take Provera would be December 11th, and it would be at least 14 days after that before a treatment cycle could start (bringing us to December 25). That's the most optimistic timetable.

This means that I have probably a minimum of 7-8 weeks before I have to worry about the effects of Depakote. Seth says it should take no more than 5 days for Depakote to get out of my system, so I'm good there. I don't know if two months on Depakote is enough to help my migraines enough, but I do know that other than ridiculous weight gain, I didn't have many horrible side effects from Depakote, so it can't hurt to try. If I'm lucky, it will take, say, 2 weeks for the Depakote to start being effective and that will still give me a good six weeks of migraine relief that I don't have right now.

If the codeine were helping enough, I'd say that it's not worth it to do this. It's a lot of trouble and a lot of ifs for some "maybe" results. But I don't think at this point I have much to lose. There's no possibility of me becoming pregnant between now and if my doctor's that worried about it, I will resume my previous practice of taking regular pregnancy tests to ensure that I'm not pregnant while taking it. (Wouldn't THAT be funny?)

I'm sure my RE would disagree with me, but my RE isn't the one who has had five migraines so far this week. Plus, my RE is on maternity leave, and I'm not calling the pinch-hitter-RE to confirm what I already know he's going to say.

So I have a call into my primary care physician's office asking to please speak with the nurse practitioner (who follows most of my care) so that I can have her call me in a prescription for Depakote. I feel good about this. Particularly in light of the fact that I don't have anything stronger than Aleve here at the office.

Quandary

So I have this envelope full of ultrasound pictures. I have about 10 of them, from various points in the "pregnancy that wasn't." I'm especially attached to the last several... the ones with actual fingers and toes. But I don't know what to do with them. On the one hand, it seems morbid to keep them. On the other hand, it seems disingenuous to get rid of them. Is there some reason I should NOT acknowledge that I had that experience? That I was pregnant and then I wasn't? Getting rid of them seems like I'm trying to pretend it never happened.

So I'm feeling like I should just keep them in their little envelope in my big ol' fertility files. But maybe I'm just being morbid. What would you do?

Things I never thought I'd wish for

Pretty high on my list of things I never thought I'd be wishing for: a negative pregnancy test. Well, I mean, sure, before I was married I wasn't praying for a positive pregnancy test either, but you know what I mean. The point is, I took a pregnancy test yesterday to see if there was enough HCG in my system to trigger a positive result. I figured this would save me the trouble of going to the lab today to get blood drawn unneccessarily. Since I need my level to be below 5 and the HPT I have reads anything above 30, I think, it would tell me if it was a useless endeavor.

Sure enough, I've never had a pregnancy test show such a definitive positive result. Nor have I seen the result appear so quickly. Yeah. So according to EPT, I'm still pregnant. Even though, you know, I'm not.

I wish there were some way to speed up the decline in HCG levels, because this is, for me, the really frustrating part. This time where I'm just sitting around waiting until I can start the clock on counting down four weeks until a provera cycle so I can move on with my life. But that clock doesn't start until my HCG levels drop below 5. So please, that negative pregnancy test can't come fast enough for me!

Sometimes I feel like my entire life revolves around my reproductive system. A friend of mine (a single, unattached, not-trying-to-have-babies friend) tells me that it's simply not true. That of course my whole life isn't about my reproductive health. But you know, in a lot of ways, my life DOES revolve around just that. I rearrange work schedules to accommodate appointments, I get back up child care for J when I have monitoring, I spend countless hours each week researching the latest and greatest in fertility science, or sometimes just reading blogs for personal accounts of this fun, fun journey. If I'm not actively in a treatment cycle, I'm spending my time either waiting for a beta, or waiting for the go ahead to start a new treatment cycle. Even now in my downtime, I've got three lab slips waiting in my bag to be taken to the lab at strategic times over the next six weeks or so. I'm still taking a prenatal vitamin. I still can't take effective migraine medicine. I still think about fertility/pregnancy/whatever at least 6 times an hour. So really, what part of my life doesn't revolve around my reproductive health? I am really, really ready to be on to the next stage of my life. Four years of total preoccupation is starting to get to me.

One more before bed

Earlier today, I read a post reflecting on where things were a year ago in the realm of fertility fun. Oddly, I'd just been thinking of writing a very similar post, because it was just about exactly a year ago that I walked into Shady Hell Fertility Shmertility Clinic and started working with the fabulous Dr. T. And here I am, a year later, finally a pregnancy, sadly a miscarriage, a year older, but not a lot wiser. So where was I a year ago? Here's the response I wrote, which I may flesh out more later, but I wanted to record it here so I don't forget about it:

Where was I a year ago? Gosh. A year ago, we'd been trying to conceive for three years and we'd had five wholely unsuccessful Clomid cycles. My OB/GYN wanted to do one more round of Clomid before referring me to the fertility clinic. I pissed her off by taking matters into my own hands and just going straight to the fertility clinic.

Almost exactly year ago I was getting 14 vials of blood drawn before I could start any fertility treatment. I was having an entirely uneventful HSG. I was still then horrified by having transvaginal ultrasounds (I've probably had another 60 or so since then, so I'm far less horrified).

A year ago I wasn't any more optimistic than I am today. I went into each cycle already planning the next. A year ago, my doctor was telling me I'd never need IVF and that a few rounds of IUI and I'd be pregnant. A year ago I had no idea what to think.

A year ago, I had never contemplated having a miscarriage. In fact, I had just figured I'd never get pregnant, so a miscarriage was inconceivable (no pun intended).

A year ago I had a blog no one knew about (now defunct), but knew very few infertiles in the blogosphere. I never figured I'd be one of "them"... I just never figured I'd make it very far at all.

I realize now, after three failed IUIs and a theoretically successful one which resulted in a miscarriage one day into my second trimester, that I actually have far more optimism than I did at the beginning of this process. When we first started trying to conceive (almost exactly four years ago), it never occurred to me that I would ever get pregnant. Now I can't wait for the next time.

All in all, I think I'm in a better place today than I was a year ago. And I'm very grateful for that.

a clarification

I realized that I may not have been entirely clear on something and since blogger doesn't support threaded comments, it seems to warrant its own post. In my last post, I referred to the rambunctious three year old in my house. Erin insightfully replied:

...Having a child already does help mitigate some of the pain but in other ways, it makes it even more painful--you'd already started to compare your pregnancy with this child to your pregnancy with your son, thinking about what it would be like to see your son as a big brother, etc...

While it's true that I do spend some time wondering what J would be like as a big brother, I don't compare pregnancies. In four years of trying to conceive, I've had only one pregnancy. My rambunctious three year old is a foster son. I don't think of him that way, because we've had him for two years and he's every bit as much our son as if I'd given birth to him. Still, it changes the dynamic for me in some ways. For example, I never got to experience my first pregnancy in the way normal people do... without other children in the house. When I was dealing with absolutely unbearable exhaustion of pregnancy for the first time, I still had a tornado of a child to take care of. And when I miscarried, even through my grief, I still had a cuddly three year old begging for attention. It makes it harder in some ways, that's true, but easier in so many others.

And interestingly, I think the miscarriage has given me a lot more patience with J. I'm not nearly as snippy. While I don't always have the emotional energy to handle him these days, I don't snap, I just find backup. He's a wonderful kid, but not without his issues, having been bounced around a lot his first year, and yet, I have more patience with him than ever. And somehow, he's instinctively known to listen more to me these past couple weeks.

I think I've done fairly well on the emotional spectrum, and I think a lot of that is because of J. I had two days (not consecutive) of complete breakdowns, neither of which were while J was home and awake. He's done a lot for me in terms of my ability to cope. And I love him just as much now as I did before. I love that I have him to snuggle with and grow with and learn with. I love that I have that little man in my life. I couldn't ask for a better companion, miscarriage or no miscarriage. Mostly, I'm sad that I will have to wait a little longer to see J as a big brother.

I'm not grieving this particular child. Morbid me took a good long look at the fetus and yes, it had arms and legs and eyes and ears, but it wasn't a person yet. What I'm grieving really is the totality of the situation. Four years of trying to conceive. One pregnancy. Lots of hopes and dreams. And those dreams aren't gone.... but they're deferred, somewhat unexpectedly. A friend of mine (a friend who has five kids, mostly grown) gave me a necklace and earrings after the miscarriage... the card said, "Something with which to remember dreams deferred. With gratitude for your friendship. Love, E." Without realizing it, E hit the nail on the head... it's the dreams deferred that was so hard to take, not this specific loss of a person.

And I'm okay. I have the best husband I could ask for. I have the most amazing three year old monster I could ask for. I have options left, which is more than a lot of people I know have. I have good doctors and even if I never had another child, I know that I have a really good life. It's just that I really want those other children. Those dreams deferred. I want to know that the dreams are merely deferred and not cancelled.

There's no possibility that this experience can be looked at as a good thing. It's a horrific, awful thing, and no one is arguing with me on that. But I must still acknowledge that there is positive to be seen in all this. It's good for a marriage to go through the hard times. It's easy to go through the simchas (joys) together, but the strength built in a marriage through the difficult times is hard to replicate. My husband, my greatest joy, has been my constant source of strength since I met him 8 years ago, and these past weeks have been no exception. There is positive that has come out of this ridiculously unfair experience, and I know that. So there you go. My little teeney clarification turned into a big mound of babble. Ah well. It's my blog, I can babble if I want to!

Moving on

Mostly I've been okay recently. I had a followup appointment with my OB on Tuesday (the 17th), and I'm healing perfectly... physically anyway. I was saddened to learn that the hospital was unable to do genetics on the "products of conception". It wasn't anyone's fault, really. The ER handled things properly according to their protocol, but their protocol was not proper for genetic testing (I guess the normal solution that such things are preserved in precludes genetic testing... I'm not entirely clear on the details). I honestly think that the inability to do genetics is the biggest slap in the face of all of this. I feel like I'll move forward somewhat blind, not knowing if this is something I'm genetically destined to repeat over and over. But the odds are that it was a fluke and not something we're predisposed to, so I'll just go with that. Still, I have to say that G-d and I aren't really on speaking terms right now. I know that's probably a fleeting feeling, and life will return to normal eventually, but that's where I am now.

Right now I have a rambunctious, excited three year old riding circles in the living room on his tricyle, completely convinced that he is the world's most acclaimed racecar driver, so what more could I ask for?

On Wednesday, I have a followup appointment with the fertility clinic. My doctor is on maternity leave, irony of ironies, so I'm seeing a different doctor. He's the head of the practice and I've liked him just fine in the monitoring appointments he's been at. In fact, he did my second and third IUIs. I know that in a lot of ways he's the best of the best, and it's his protocol that has made this clinic so successful. Still, I'm sorry not to have Dr. T. who is just an incredibly special person as well as an outstanding physician. I'm mostly afriad of feeling like I have to start from square one if I'm seeing a different doctor. But I just can't be the only person having to have a doctor substitute, so they must be used to this. I know there are some things that I am back to square one on... it's been about a year since a lot of the testing that they run annually has been done. I know my OB re-ran a bunch of the infectious disease testing, but it may be less complicated to let Shady Hell just re-run everything rather than trying to piece together what still needs to be done. I don't know that they'll make me do another HSG (I hope not... I didn't find it uncomfortable like some women do, but it's just more time off of work that I can't afford). I know they'd make me take another course of doxycyclene, but I had to take a round of it after the D&C so that's probably a moot point.

I hope Dr. S. has some reasonable answers and that I don't have to wait months and months to get back on track. I don't want to do IUI anymore. Too many side effects for results far too low, but I'm somewhat worried that Dr. S. will say, "well, it worked once, so we know it works, let's just try again." I doubt he'll actually say that though, since I'm pretty sure they don't make much money off of IUIs, and IVF is their real cash-cow. A physician friend of mine, who had twins with IVF last year, told me that her medical opinion (despite not being an RE herself) was that my only logical next step is IVF with PGD, but I find it hard to believe that one late miscarriage, with no conclusive answers as to WHY it happened equals jumping to PGD, though she's right that it would cut out the risk of having to go through this again blind. Still, something about that scares me. I mean, if we do straight IVF and it doesn't work, we've still got an option... IVF with PGD. But if we jump straight to PGD, that's basically our last option (our rabbi doesn't allow donor eggs or sperm, so really, IVF with PGD is the last choice). There's something psychologically painful about jumping straight to my very last resort (especially since it's unlikely that my insurance will cover PGD at this point without a few more ridiculously late miscarriages... ugh!).

Anyway, I'm babbling, but that's where I am. I'm frustrated to be without a plan. I'm a planner. I always know what my plan B is. Throughout my pregnancy, I was making plan B, plan C, and plan D. I never entirely expected to make it all the way to April with a baby intact, and I was only JUST getting used to the idea that the pregnancy was probably here to stay for a while. So here I am, thrown for a loop, with no plan for the foreseeable future, and THAT is the hardest part of all.

What's been happening and a letter to my OB

I hadn't been able to keep any food down at all last week, and by Friday I couldn't keep fluids down either. Couple that with some pretty serious cramping (getting progressively worse) and I landed myself back in the emergency room Friday night. Many of you probably know that I'm an Orthodox Jew, so this was somewhat complicated, as it was the Sabbath for me starting at Sundown, and there are all manner of Sabbath restrictions, including no driving, so I had to make arrangements for someone to drive me home once all was said and done and it was just more complicated than I would have liked. Also, I sat in the waiting room for 3 1/2 hours before they remembered I was there (they admitted to having forgotten about me, so I'm not just being bitter when I say that). Anyway, the cramping doesn't appear to have any important cause... they did an ultrasound and everything looked okay. I wasn't so much worried about the cramping as I was the dehydration, but they gave me IV fluids and antinausea medication on top of the lovely pain medicine they'd already given me. I was pretty happy then.

Now I feel like I've been doing situps all weekend, which is ridiculous, but unpleasant. The pain hasn't subsided in the least, but I'm happy that there's no good cause for it. I have an appointment with my OB on Tuesday, but I expect I'll be fine by then (but I still have to see him regardless to follow up re: the D&C so that he can make this month's car payment).

Have I mentioned lately how much I love my OB? I just can't get over how wonderful he was to me on Monday night. So I wrote him a letter. I have no doubt that he gets a lot of letters and baby pictures when everything goes right. But I doubt he gets a lot of positive acknowledgement for his role when things don't go right. So here's what I wrote:

Dear Dr. B;

I am writing to thank you for the exemplary care you provided me on Monday, October 9, 2006 when I had a miscarriage and subsequent D&C at HC Hospital 12+ weeks into my pregnancy. I would like to take a few minutes to explain to you why this means so much to me.

After four years of trying to conceive, five rounds of Clomid, and four IUI (with injectible gonadatropins) attempts, I was caught by surprise to find out I was pregnant. When my doctor at Shady Hell Fertility Shmertility Center, Dr. L. T., told me that what had originally appeared to be a miscarriage looked like a viable pregnancy, I didn'’t experience the same joy that I imagine most newly-pregnant women experience. Rather, I was afraid. I was afraid to leave the safety net of the fertility clinic and the rapport I had established with the doctors and staff there. I was afraid I wouldn'’t find an obstetrician I could trust. Most importantly, I was afraid I would miscarry before I even made it to my first pre-natal appointment. I had never given much thought to finding an obstetrician I could trust, under the assumption that it would never become relevant.

On the recommendation of Dr. T., and the recommendations of other friends, I made an appointment in your office for September 20th, 2006, when I was 9 ½ weeks pregnant. I knew at my first appointment with you that I had made the right choice. You took my concerns seriously, but were not overly anxious (your words were, "“It’s really hard to mess this up; women have been doing this for a long time”"). I had been experiencing bleeding throughout my pregnancy, and you carefully reviewed my medical history, the records provided from Dr. T.'’s office, and did a physical exam to ensure that there was no cause for alarm. I appreciated your calm, but thorough, nature immediately.

At my next appointment on October 4th, everything seemed fine and we heard a heartbeat and all was well. I asked if I needed to have any concern, as the bleeding I'’d been experiencing had increased dramatically the previous weekend. Though we had not planned to do an ultrasound at that appointment, you immediately offered to have an ultrasound done to make sure nothing was wrong, even though it was likely nothing to be concerned about. Sure enough, the baby was fine, measuring exactly 11 ½ weeks, with fingers, toes, and a heartbeat. You told me I had a subchorionic bleed, something I should not be concerned about, which does not cause miscarriages, and would resolve itself on its own over time. It was a relief to know that it wasn’t all in my head. In retrospect, I am very grateful that the ultrasound was performed that day, because it gave me a glimpse of a healthy baby, something I never thought I would see on an ultrasound of my uterus.

Despite two promising appointments, and a total of four promising ultrasounds, on Monday, October 9th, I began to have severe contraction-like pain, with significant bleeding. I paged you, but within a few minutes of paging you, the contractions had become so frequent and severe that my husband put me in the car and drove me to the hospital. (Upon my return home, I discovered that you had called back a few minutes later, and followed up with another call to make sure everything was okay) An hour later, I miscarried in the emergency room and the ER physician, Dr. G., called you. I expected that I would either be told to go home or a doctor I didn'’t know would perform a D&C if necessary. Instead, I received a phone call from you directly, something which I genuinely appreciate, though it was neither expected nor required. In our short conversation, you expressed sincere regrets and assured me that there was nothing I could have done differently to change the outcome.
You made immediate arrangements to come to the hospital and perform a D&C as I was still in tremendous pain and experiencing heavy bleeding. Your swift response was extremely comforting.

I learned later that you had spent the entire day at the hospital, and I know that my call pulled you away from your wife and your family after what must have been an exhausting day. Yes, it’s “all part of the job”, but I know that it takes a special kind of dedication to enter a profession with those kinds of demands on your time. I experienced tremendous relief when you arrived in the OR area where I was filling out forms and waiting for the D&C. You quickly reviewed the pregnancy history with my husband and me, and again expressed your sincere regrets for the loss we had experienced, and suggested some options for finding answers to the questions we have regarding why I experienced such a late miscarriage, saying that you would be as aggressive as we wanted you to be in finding out the answers. I know that a first miscarriage in a first pregnancy is not normally cause to aggressively seek such answers, but given my history of infertility, I am extremely grateful for whatever answers (if any) you are able to uncover. Once again your calm, but thorough, nature was comforting for both my husband and me.

Your gentle care, your thorough manner, and your swift response made a real difference in how I will look back on this otherwise rather unpleasant experience. I never felt anything but complete confidence in the care you were providing, or the choices we were making. And I have never been so certain that I chose exactly the right provider for my obstetrical care, no matter how short that care period turned out to be. I cannot thank you enough and I hope to someday soon enter your office with news that I am pregnant again.

Sincerely,

KEC

It wasn't an easy letter to write, but I'm glad I did. It was rather cathartic, but more importantly, I'm glad I had an opportunity to communicate my appreciation to my doctor. He was extraordinary.

insult to injury

I called to make an appointment with my fertility specialist. I trust my OB and I know he'll be very aggressive in trying to determine the cause of the miscarriage, but I also know RE's and OB's sometimes look at different sides of a problem, so I want to make sure they're communicating with each other. I don't want my OB running a battery of tests and then three months later having the RE say, "why wasn't this test run?" I don't want two rounds of testing. I want it over with. I want to know what the next step is, even if the next step is "do nothing." I love my fertility specialist. She always treats me like I'm the only person on her mind; she remembers random things about my life; she listens and considers her answers to my questions carefully, and she asks appropriate questions.

She is also, apparently, on leave for at least three months. I hope everything is okay. I don't know why she's on leave, but she didn't mention it when I saw her a few weeks ago, so I'm guessing it was rather sudden. I'm worried about her, but my selfish self is, well, being selfish. I want her, not some substitute!

I have an appointment with another doctor in the practice, a doctor I have a lot of respect for and whose opinion I trust. In fact, there's only one doctor at that office that I don't care for, so I really had my pick of a lot of really good doctors. Dr. S. has been in the business a long time, he's the best of the best in a lot of ways. He's funny and smart and he listens to me when I see him for monitoring appointments and I know he'll be a fine subsitute. I always knew if I hadn't been originally scheduled with Dr. T, that I would have been very happy with Dr. S. But he's not her. And he doesn't know me. And I'm a lot more than what's in my chart. So my selfish self is pleased to have such a fun, amazing substitute who knows the field as well as anyone else, but sad to not have Dr. T to turn to right now.

Mostly, I just want to know where to go from here, in as prudent a fashion as necessary, and I want input from both sides of the fence (OB/RE sides), so seeing Dr. S. is fine. I just hope I don't end up feeling like I'm starting from scratch.