The Crossroad and the Aftermath

Thursday, 18 June 2015

Disclaimer: This blog post may contain description which could be graphic or distressing to readers.

In the last two weeks I feel it's safe to say that my husband and I have encountered a number of crossroads whilst trying to overcome the miscarriage obstacle...

Which direction do you choose to take in conversation?

Which way do you respond at the rescan? Which choice do you make if they ask whether you want to see the ultrasound screen?

Which choice do you make when given the "management" options?

Which face do you pin on? At home? In hospital? In public? To friends? To family?

Even harder, which face, if any face, do you pin on for each other?

At the first sign of bleeding, at 2:50am on Thursday the 4th, I called my midwife service and was recommended to attend the A&E at my local hospital. Unfortunately, all they could do was have me checked over externally by an ED doctor and be referred to the Early Pregnancy Unit, as no internal ultrasound equipment is available outside of their clinic and they are only open Monday to Friday 9-5. Ever grateful for living right by the bus which runs 24 hours, right past the hospital, we were able to get in and back without fuss, and returned to the unit a couple of hours later. A&E can only generate paperwork, despite their claim of making you an "appointment", and so at 14th in line, and still bleeding, we waited 2 hours to be seen by a doctor.

After all the awfulness that came with being told by the gynae doctor, and then the consultant, that there was no heartbeat, and being comforted by the attending nurse as I broke down, we were told that because it was my first pregnancy, I would have to return in seven days time for a rescan in order to confirm that the pregnancy was no longer viable.

We left the clinic with nothing but our shattered selves.

With only a week until our nuchal dating scan had been due, not even the knowledge of the commonality of miscarriage could have prepared us for that moment, or the days which followed.

We had nothing to go on, no literature to refer to from the hospital: just the instruction that if the bleeding intensified to a particular level or I began experiencing high levels of pain, then we should return to A&E. Otherwise, we must wait.

But we couldn't wait. How could we? We knew that with the report stating the embryo was undersized and no heartbeat was detectable, along with the seriousness of all the faces in the room and free flowing sympathy of the attending nurse, our dream had reached, for this journey, the impassable. There was absolutely no error in my dates; even the doctor had said as much to the consultant. Perhaps in the back of my mind was that tiny sliver of hope that I had got something wrong, that the next week we would hear the miracle heartbeat start... but honestly that's probably optimism smeared in broad brushstrokes to reduce the memory of crushing despair. It was over. There was nothing to hope for.

As I called home to my Mum in Australia, on the bus back to our flat, and relayed the news, I felt the air slowly escaping me. With every few yards we covered between the hospital in Denmark Hill and our home in Forest Hill, I became more and more like a discarded balloon: one of those you try in vain to inflate, but the bastard just won't get past a certain point and so you let it deflate and chuck it to the side in arrogant defeat. Our baby was gone. Our baby was gone, and there was nothing I could do.

The next week passed with a quagmire of emotion, of disbelief, distress, disappointment, devastation, depression... Of painful, flowing tears... Of completely raw, stinging, open wounds... Of utter numbness. To call it a roller coaster is a pitiful metaphor, and yet all too appropriate. It's one of those blind ones, where you've heard there are unexpected twists and turns, and inversions, but until you're strapped into it with no chance of getting off until an external force applies the brakes, you are at the mercy of someone else's creation. You cannot script it. You cannot adjust it. You can predict it, but even then you can be upside down and back up before you realise what just happened.

Writing the first post on this new blog helped me extract some of the swirling thoughts from my mind, but instead into the vacancy washed hour after hour of confusion, grief, loss, and agony.

The day before the rescan, while my husband attempted his first day back at work, I looked up the management options available to me to deal with the miscarriage, thanks to the Miscarriage Association, and read some recounts of experiences from other women. I managed to successfully terrify myself. I had been stop/start bleeding for six days, still without any pain, and with no indication that the miscarriage was advancing. Physically I needed it to be over so I could regain control of my body - emotionally, it had to end. I could no longer handle waking from another "sleep" filled with nightmares, only to find my body had ceased bleeding during the night and was again waiting to screw with me in my waking hours.

I had three options: Natural, Medical or Surgical. All come with positives and negatives. The Natural course is exactly that, waiting for the body to naturally pass the tissue or to reabsorb what remains and pass it during the next menstrual cycle. Medical Management involves taking tablets or using pessaries to cause the uterus to contract and push out the tissue, akin to labour. Surgical Management is with local or general anaesthetic and, slightly unlike the D&C procedure, involves a vacuum evacuation of all the tissue. The stories of people electing Medical Management caused my terror, with their contracting pain and large clots, of passing the gestational sac and contents into the world and being able to see their miniature baby. I shut down. I couldn't be alone at home, waiting for this.

Forty-five minutes before the Unit opened for walk-in appointments the next day, we were still 5th in line to be seen. An hour later, with a different doctor, I had to retell my initial problem and the details of the past week. I had tried so hard to hold it together all this time, but now faced with the stirrups and instruments, I felt my composure start to crumple and fall away. I declined her offer to wait until I was "less emotional", and let it start. My husband held my hand, and together we waited for the news we already knew was coming.

...Just keep breathing...

She explained the findings and then, much to my distress, she turned the screen around to show us what she was talking about. In that alien image, supposedly belonging to my insides, sat everything we had lost. In all its smallness. In all its departure. The consultant came to confirm. My feet still in the stirrups, the doctor explained the three management procedures. She said that the Natural option could take up to another six weeks before actually producing results. I was already vehemently against the Medical option. Both had no guarantee of not requiring the surgical option anyway. I elected Surgical - I wanted it over. For both of us. For all of us.

The following day I travelled alone to King's College Hospital for the surgery. Day Surgery doesn't permit companions due to the limited space, and it seemed pointless to drag my husband down to drop me off at reception and then go home and wait to return and collect me. I felt overwhelmed by "irrational" emotions. I knew there was nothing I could do to save the baby - while the doctor could estimate the week it stopped growing, there was no way to tell just how much longer it had held on, or whether it ever had a heartbeat at all. I knew it needed to be removed for the health of my body and mind. But all of a sudden I was fiercely protective: the only thing I had managed to do was hold on to it for as long as possible, for nearly 13 weeks now, and keep it safe. Now I was hours away from it being suctioned from my body and destroyed. I didn't want them to take it away from me. I wanted to keep it safe from harm forever.

In reception, not even Bargain Hunt on the television could save me. Silent tears rolled, much to my shame, and dripped at their own will. A woman on the next block of seats moved to sit beside me. She asked if I would like the company, as she figured we were all waiting for pretty much the same thing. She was called in soon after, but that moment of kindness from a perfect stranger had helped dim the darkness. A little later, I was called forward with another woman. Her friend asked questions about picking her up and how long things would take... I watched the woman start drooping as the seconds passed. First the corners of her eyes, her mouth, then her shoulders slumped and she started quivering. As we were walked through the door to the wing, I heard myself say to her that if we were close to each other on the ward, I would keep her company if she liked. She turned to look at me, and whispered thank you, before her tears started to flow. Strengthened by the kindness shown to me in reception, I reached out and took her hand and she grasped it tightly. My own tears started to fall again but now, in those few moments as we walked towards our fate, neither of us were alone.

The hours on the ward passed in a slurry of the same questions, signing consent forms, vaguely reading the free newspaper, being measured for stockings, and waiting inside my little blue curtain cubicle, cut off from the world. I was walked into theatre, mercifully blind from having no lenses in, and as I lay on the gurney and saw the smears and blurs of the room being assembled, the tears just trickled free. The anaethetist injected a relaxant into my cannula and soon everything slipped away...

The aftermath of surgery was fuss-free, although the cramping whilst still on the ward was unbearable without more pain relief. The surgeon was pleased that all went well without complication. She talked me through trying again soon, so that it would try to stop my depression surging up and paralysing me with the fear of ever trying again, and also so that if I were one who miscarried again, they would be able to see if there was a genetic problem or reason for it, sooner rather than later.

I am now physically through the ordeal, nearly a week later. Some bleeding is still expected, but it is now manageable. Psychologically and emotionally however...

It has been hard to explain the process to people without any experience of it. People have assumed that when you say you've miscarried, everything is over in that moment. Confusion has been painted on faces in trying to comprehend why I had to wait a week for a confirmation, and then my procedure. "But surely it was over when you started the bleeding..?"

I am trying incredibly hard to let it all go, and leave it behind me. I feel compelled to attach a brave face before being around people I know, afraid to cry or express true emotion in case they don't know how to handle it. At home, around my husband, I also try and leave the mask in place... I want to save him from my grief, while he copes with his own. I don't want him to worry - I want him to find his "normal" again and be okay in this world without our baby. I know he wants me to be open and honest and not push him away. I am afraid to take off this mask, for fear of what lies beneath it. I feel as if the holes I have drilled into my face, to hold it on, are slowly tearing and infecting and filling my heart with yet more pain.

But how do you find "normal"? When will it come back? Will you ever be that person you were before?

People haul you up to standing now, brush your dust off, and say that thousands of people are going through this, and the world hasn't got time to stop and wait for you to catch up. Get back on the train of life. Make normal things happen. Keep going. It will get easier. It's common. You're no different to anybody else.

Two weeks ago today, we were shoved onto a crossroad and left to find our way out, with no signposts. No guidelines. No road rules.

Normal may come, but normal is relative. It takes time. It is different for everyone. Grief is not identifiable as one particular colour. It will change with the light, with the weather, with an individual outlook. It takes time to understand, to comprehend, to accept, to assimilate. There is no cookie cutter way of responding. Of recovering. Of learning to let go. Of saying goodbye.

A friend wisely stated that no one is perfect. Except David Bowie and cats.

I think there might be something to that.