Forewarned is forearmed, so walk away now if you don’t want physical details.  We went back to the fertility specialist today for a follow-up and a next step discussion.  We were supposed to see another doctor tomorrow who might have taken a different tack, but her office called Friday to tell me she had resigned.  So no appointment tomorrow; we may wait a while and see if she turns up somewhere else, but I wonder if maybe God just shut that door to leave just the one open.

Today was largely what I expected: based on the hcg level last week, they drew more blood; the doctor reviewed the results of trying lovenox; and he recommended IVF based on the idea that maybe our embryos aren’t implanting in the right place.  Before I explain the blood work, we are going back in October to start the tests needed to begin IVF, which would put us somewhere in January starting the first cycle.  Given that our most recent loss isn’t really completely over yet, we would have to wait another month to start the process, and that would have put us waiting for a pregnancy test right before Thanksgiving if we started the IVF procedures as soon as possible.  We could end up pregnant anyway, but I’d prefer not to intentionally schedule a potential pregnancy (which I mostly see as a potential miscariage) at the start of the holiday season.  Christmas sucks enough for me without scheduling potential disasters to happen at the same time.

Now the blood work: I went last week for a repeat hcg check to make sure that the level was dropping.  It should be below 5 to be considered negative for pregnancy; anything over 25 is considered positive for pregnancy.  It was 46 last Wednesday.  That was slightly less than half of the highest level I had, but it was 54 the week before, which means it barely dropped over that week.  I’ve never had the level not drop to negative a week after a miscarriage.  It is not really unusual for it to take several weeks to drop back to negative, but it is unusual for me, and most of the people whose levels remain elevated for a while had hcg levels well over 1000 when they miscarried.  We won’t get results from today’s blood work until tomorrow because the person who processes the lab work was out of the office and will return in the morning.

Before anyone goes nuts and thinks that the hcg level remaining elevated could be a good thing, it’s not.  Remaining slightly elevated without going away is often called a missed miscarriage; in clinical terms it means that some “products of conception” remain somewhere in the body, which can cause a lot of fairly disgusting complications, infection and internal bleeding being among them.  So continuing to show positive on a pregnancy test does not mean we may still have a viable pregnancy.  There are plenty of chat room stories of women who had miscarriages but discovered several weeks later that they were still pregnant, but even they point out that the hcg numbers then continued to rise dramatically like they should have to begin with. All things are possible with God, so I can’t say he wouldn’t do that, but I can tell you I will be furious with him if that were the case for us right now.  I’m very sure it’s not because of the next explanation.

This is the part that I warned you about, so you have one more chance to walk away.  I have been bleeding for three weeks at this point.  I started bleeding lightly about a week before we got the news that my hcg levels were dropping.  The day after that news, I began what I assume to be the miscarriage, which was much heavier bleeding and cramping.  It slowed down after several days, and I expected it to stop in about a week, which is what I have done all but one time a few years ago.  That time I continued spotting (different from bleeding), but we had a negative hcg level.  I am still bleeding, and it even picked up the pace yesterday.  The doctor would like to watch this for another week or two to see if it resolves on its own.  The alternative is moderately invasive surgery.

I am SOOOOOOOOOOOOOOOOO frustrated right now, and I have no idea what to pray for.  I find that I am once again almost hoping that there’s a problem.  Surgery would mean a d&c and laparoscopy to try to find the pregnancy, and that is obviously not an ideal situation.  But surgery could possibly mean that they find the pregnancy, which might be useful in determining a definite course of action.  If it’s in the uterus, it would tell the doctor that IVF is not a good idea; if it’s outside the uterus, it would tell him that his hunch is right and we stand a pretty good chance of success with IVF.  While a natural resolution is obviously better, I have no words to describe what the potential for another two weeks of bleeding does to me.  Because of the low hcg level numbers, there’s really nothing to see by doing an ultrasound or pelvic exam, so the only option is to wait and watch.

If the hcg level has continued to drop based on today’s blood draw, then by next week it should be negative, and maybe this will end soon.  So I guess that would be the best news tomorrow.  I suspect that it will not be the news I get tomorrow, but that may just be the crazy hormones talking.  If the hcg level continues to hover for the next week or two, or if I develop any symptoms of a complication, then we will definitely be doing the d&c.  I just really want this to end immediately.  I started typing that sentence with “need” instead of “want,” but I realized that the only thing I need is to let go of this and wait and trust God to keep me sane.  Far easier said than done.  I’ll let you know what we find out tomorrow.

Yesterday morning I really wanted to post the following status on Facebook: Today stinks, just in case you were wondering.  I didn’t post anything because I didn’t want a positive reaction from anyone.  I wanted to be miserable, and I wanted someone to know I was miserable, but I didn’t want or need anyone to try to cheer me up.  Since a cheerful comment would have only irritated me, and I didn’t want to think bad thoughts about any of my friends, I decided I should keep my post to myself.

If you have a single bit of empathy, you don’t want your friends to be miserable or hurt; your first reaction is often to cheer them up or try to encourage them out of their funk.  I’d say most of the time this is a great thing, but maybe we should allow just a little bit of funk sometimes.  We mean well, but there are times when people need to feel sad or pained or other than positive.  We need to allow each other the space to feel what we’re dealing with without pushing the person to feel something else instead.  For instance, I needed to be sad yesterday – I needed to cry or howl at the moon or scream or break dishes without anyone telling me to feel better.  It has barely been a week since the pregnancy loss; I think I am understandably negative about the situation.  I will not be sad forever, and if I’m sad and depressed for more than a few weeks, I trust that someone will encourage me (you may read “encourage me” as “kick my butt” if your name is Melissa) to move on.

While it is true that as Christians we should give thanks and find joy in every circumstance, I would encourage you to never, ever tell that to someone who has just lost a loved one or experienced a personal trauma of some sort.  It is acceptable and normal to feel negative emotions, and you must allow yourself and other people to feel them.  It is not normal or even healthy to only feel happiness.  If your friend is a sincere follower of Christ, they have not forgotten that they have the deep and abiding joy and peace of Christ in every season of life.  Reminding them in the face of their loss that they should feel joy and give thanks will probably feel like a slap to the face of their grief.  Wait for them to experience the loss and then pull them gently back to joy if they haven’t already found it.  Sometimes you need some space to gain the perspective that allows you to see the joy in a devastating circumstance.

Our Sunday school class must share a joy each week with the rest of the class.  I love this exercise because it “forces” us to consider the week and find something good that came out of it.  I don’t think anyone expected for me to have a joy to share last week, but I have been able to experience true friendship in so many ways over the last two weeks that I give thanks for my friends.  I hope that as I continue to move past this recent loss that I will find more joy and more reasons to thank God.  That is the deep love of Christ working in me, because I alone would not be able to thank God for anything related to another miscarriage.

If you have a friend experiencing loss or frustration of some kind, I encourage you to consider your responses.  If they are acting out of line (for instance, I am a jerk when I’m upset and tend to snap at others), gently call their attention to the bad behavior.  If they are just experiencing a normal emotion related to the loss, express your sympathy and offer your support without telling them to buck up, cheer up, find the bright side, or anything related to bootstraps.  You don’t mean it, but by telling your friend to change their feelings, what you are telling that person is that the negative emotion is not acceptable or appropriate.  Allow your friend to feel whatever they feel, no matter how ridiculous you may think it is.  Once they stop making forward progress or can’t work through the depression, then encourage them to find some professional help or change their outlook.  I cannot express how invaluable is the friend who can accept you as you are; those are the friends that you will listen to when you need your butt to be kicked.  If you want a friend like that, be a friend like that.  And carefully choose when to cheer and when not to cheer.

Several years ago, I convinced my best friend to be my training buddy for the Frantic Frog Triathlon in Scottsboro, Alabama.  I believe she eventually came to forgive me. 🙂  We had a blast with matching suits and no expectations or delusions of grandeur, and we had the greatest cheering squad ever.  We were not fast, and our transitions took as long as some people took to complete the entire course (those are the aerodynamically built people, which I have not been in some 20 years), but we enjoyed every moment.  We are going to try it again this year in spite of the abbreviated training time.  If you would like to join us, you can find out more about the race and get registration information at: http://www.scottsborotrisport.org/  The race is September 10 in Scottsboro, and you are welcome to participate or join us to cheer and eat lunch afterwards.

If you think you’re interested, but you’re afraid of doing a triathlon, don’t be.  This is a great beginner-friendly course: the swim is shorter than a standard sprint distance; the bike course is a little longer, but it’s mostly flat; and the run (or in my case, walk until you see fans or photographers…) is hilly, but at that point, you’re almost done anyway.  With only about six weeks to train, we will not be fast this year, either, so sign up and join us!  Our motto last time was, “Don’t be last!”  But I’m thinking this year it’s going to be, “Just get done, and pretty doesn’t count!”  If you’re still on the fence about whether or not you could participate in a triathlon, send me a note or call me – you can do it!  When we nail down race day details, I’ll send out an official plea for cheerleaders. 😉

I have had the distinct feeling over the last several days that my emotional response has been lacking or even completely inappropriate, like people who laugh uncontrollably at funerals.  Wednesday, I was so relieved to at least have an answer that I was happy and upbeat the whole day.  I didn’t cry even though I wanted to.  I took the rest of the week off, mostly because I knew Thursday and Friday would be the worst part of the physical pain, so I’ve been in a bubble of Tour de France watching and crocheting.  I watched the movie Rent Thursday, and that was maybe the first time I really cried.  And it was the only time I cried Thursday.  Friday I cried because a doctor that came highly recommended from a friend who had similar problems is at a practice that I hate but not because we lost the baby – it was just a tiny taste of the frustration I know I’ll be feeling soon.  I’m glad for the respite, but I don’t want to put off dealing with the emotional pain; the longer I avoid it, the worse it bites me in the rumpus when it finally catches up with me.

Unreality is easy in the short-term – I’m not at work, so I’m not dealing with my normal daily stressors; I’m not doing normal housework or cooking or anything that generally grounds me in reality, so I’m not dealing with my normal daily life right now.  I’m on vacation, or at least my heart seems to be.  I can try to draw it back, but I can’t really make myself concentrate on feeling anything right now.  Maybe my heart’s not ready to deal with this, and that’s okay for a few days or maybe even a week, but I can’t ignore it forever.  I sort of thought that the physical pain would pull me back into reality, but I think I’ve dealt with so much stress from the cramping and pain of the last week that unreality might be the best coping mechanism for a few more days.

Long term unreality will just allow the frustration and anger and pain to hide for a while and then pop out at inopportune moments.  That’s why I would rather scream and cry now, even if it’s directed at something else.  Maybe I should watch more sad movies or talk shows I disagree with: I could vent the emotion that I know is peeking out from under the covers right now.  Maybe I’m just tired of working through the stages of grief only to start all over again and again and again.  I am too tired to be angry, but I would like to get a jump-start on sad, depressed and bargaining – they hurt the worst.  I could pretend that I’ve just jumped straight through to acceptance based on my attitude and emotions since Wednesday, but I know I’m really just on step one: denial.

Denial isn’t so bad for a short while; I have had a few days to relax and regroup before the real work starts, I’ve been able to watch the most exciting stages of the Tour de France without feeling guilty for not doing housework or something productive instead, I’ve given myself a pass for the first time in ages about not being productive (partly because I’ve been working really hard for the last few months, so I’m not as stacked up as I have been), and I’ve leaned on friends at a time when I would have normally pulled away.  Now I trust that those friends will still be there when the ugly emotions show up, and I know most of them won’t run away.  Actually, I don’t think any of you would run away.

I have begun to understand far more deeply than I ever imagined what Jesus meant when he said, “My mother and My brothers are those who hear the word of God and do it.” (Luke 8:21)  Jesus was responding to his family sending for him while he was teaching; most scholars agree that they were concerned with the direction his teaching had taken and the effect it was having on his reputation and the family’s reputation.  I have no lack of familial support, but I have friends that I count on as family, and my church family has been a sweet and cherished example of “those who hear the word of God and do it” from our first announcement; you all are certainly family now more than ever.  To that end, if you’re in the Birmingham area and don’t have a church home, you should definitely try Green Valley Baptist – I doubt you will ever find a sweeter fellowship or staff more dedicated to ministry and missions.  I’m a little biased, but I’m right. 😉

Today, I’ll putter around some more and attempt to clean the house and crochet some more.  Maybe Sunday will be more conducive to reality since I should be following a schedule and seeing people.  Seeing people always brings reality rushing in because they are dealing with the loss, too, and they will be offering words and hugs of condolence.  You cannot help but react to physical contact, and, as difficult as it may be for me to finally accept another loss, it is a necessary step forward in healing and moving on.  I have the incredible benefit of being surrounded by family when I finally face reality.

Our hcg level dropped to 50 today, so we know that a miscarriage is imminent now.  I will stop taking the lovenox shots, I have to go back next week to re-check the hcg level, and we’ll still keep our follow-up appointment on August 1.  By next week, my hcg level should be back to zero unless there’s a problem.

I have no idea what else to say: I’m too numb to have really processed this information, even though I rather expected it after last night.  Thank you for your love and prayers and encouragement so far; I’m going to need it even more in the weeks and months to follow.  The path through grief is not easy or short no matter how much I would like to skip it.  Pray that God will hold us together through this and continue to show his love and grace through our family and friends.  I love you all, and I would not make it wthout you.

I think I have mentioned before that I am not a patient person; limbo is not a good place for me.  I think we humans are hardwired to avoid uncertainty – I am, at least.  Today’s blood work is yet another mixed bag that adds up to wait another two days and re-test.  My hcg level was 109 today, which is double from the 54 on Thursday.  Double sounds good, except that was a four-day span instead two or three, so I really should have been closer to 150.  109 is low, so we have to check it again on Wednesday.  Did I mention I’m not a patient person?

If the physical details are too much, skip this paragraph.  The physical side without the hcg numbers is still a mixed, though mostly bad news, bag.  I have continued to be crampy, and I have been bleeding off and on since Saturday early morning.  It has not been very heavy, so it doesn’t signify an unavoidable miscarriage.  However, it is not generally harmless spotting, which is pinkish or brownish; this is definitely bleeding.  I certainly do not feel very good physically.

This is a terribly frustrating place to be: we still have no idea what’s really happening, I’m still bleeding, and I’m still pregnant.  I know I rarely do things the easy way, but it would be nice to have a clear yes or no, which I have only had for the first two days out of the last week.  The way my body felt Saturday, I was sure this pregnancy would not last the weekend, yet here we are.  I have no idea what to think except that things cannot continue the way they are.  Pray that the bleeding will stop for the rest of the pregnancy if it is going to continue.  I can deal with the pain of cramping, but the fear that goes with bleeding and spotting is not easily conquered.  I know it can be “normal” to spot and/or bleed, but normal isn’t really part of our pregnancy vocabulary, and I can’t handle for much longer the constant fear that the bleeding is causing.

Before you feel tempted to barrage me with instructions to keep hoping and believing – stop.  I know that, it doesn’t help for you to say that, and what I really need are prayers and thinking-of-yous.  I am frustrated and sad and angry at this situation; I have not given up hope or faith in God.  I appreciate more than you can ever know how much you all have supported me, and every comment has bolstered me in some way.  I fully trust that God is working here, and some of the beautiful things you all have said and done are the constant proof of his work that I am clinging to right now.  Whatever happens in the next few days, I know that this baby and I are loved more than I ever imagined and that God is in control, even when I have no idea what he’s doing.  I also know that he has provided for all my needs so far and that he will continue to do so; let’s just pray that doesn’t involve any more bleeding or much more waiting.

I was preparing to give everyone a great update about our blood work Thursday.  The hcg level went up from 17 to 54, which is more than double and the first time my hcg level has ever done what it is supposed to do.  We will have another recheck on Monday, and we have a follow up appointment with the doctor August 1.  If everything goes well, we should be able to see something, even if we can’t see the heartbeat yet, on the ultrasound.  I have done well with the shots, much to the surprise of everyone who knows how I react to blood.  My mother Blessed is very proud.

I had some slight cramping Thursday with some very light spotting, so I put myself on light duty and loafed it for a few days.  By early this morning, however, the cramping became more frequent, and I started bleeding. It is light bleeding, but bleeding that is not spotting at this point is a sign of threatened miscarriage.  While it was only light spotting and cramping, I could convince myself that it is a normal symptom in early pregnancy; I could push the fear and pessimism away.  Now I hate myself for feeling like I’m giving up – there’s a chance that the bleeding will stop altogether, and the blood work on Monday will be perfect. I hope every time I check and the bleeding tapers, and I hope every time I have a few minutes or hours without cramping that it’s still a possibility.  But it is a new and crushing blow every time I cramp up and every time I find more bleeding as long as I hold onto that hope.

I feel so numb right now that it feels like I am sitting outside myself as I type within eyesight of the Buy Buy Baby coupon I kept to celebrate our good test results on Thursday. I had planned to go buy something for the baby with it after we got another good result Monday.  I wish I could cry and scream and sob right now because that would at least release the terror and the tension of the last few days, but my body seems to be waiting.  Waiting for what, I’m not sure – the pain, the blood, the ability to cry, the frustration and angst that necessarily accompany this experience? Maybe my body is giving my mind a chance to catch up, a chance to realize what emotions I should be feeling even as my body feels them.  Maybe God is giving me a respite between the bouts so that I have time to adjust from terror to raw pain.  Maybe I am just too tired to be able to process it right now, but I feel as the earth before God spoke over the waters – dark and void and formless.  Maybe I am over exaggerating a harmless pregnancy episode. I don’t think so, but anything is possible.  It feels as if I will know one way or the other before Monday, but we’ll at least know what the hcg numbers are doing then.  Until Monday, we’ll just keep doing what we’re doing and wait to see what happens.

I know that there are a few people that I should have contacted directly – I hope you will forgive me for not being able to rehash this several times over the phone.  I don’t really have the heart for it today.

I got a spa gift card for my birthday, which is a great gift for me.  I love getting massages, but I rarely make myself an appointment without some kind of prompting, like a gift card.  Realizing that the card expired a week sooner than I thought, I called the Monday afternoon that it expired to get an appointment and was told I could just show up whenever I wanted.  That’s a little unusual but maybe not completely weird if it’s a new place or if they’re just not that busy on Mondays.

I arrived at the spa in the mall to find two very sweet girls tending the store front, and I reported the gist of my earlier phone call to Moon (yes, Moon – she is the proprietor and sole scheduler).  The girl who appeared to be in charge took my gift card, looked it over, and said, “Okay, I give you neck and back massage, okay?”  Okay by me, so I nodded vigorously.  The girl directed me to a room in the back corner of the spa and told me to wait and she will bring me a towel.  Since I never learned the girl’s name, I have decided to call her “Bob,” as it fits with the absurdity of the proceedings to follow.  The massage room I found myself in was sparsely  equipped and contained an undraped massage table.  Bob returned with the promised towel and instructed me to take off my top and lie down with the towel covering me.  I began pondering the logistics of a single towel versus the amount of naked table and naked skin that must be covered, but I nodded my understanding to Bob anyway.  I determined that wrapping my top in the towel in the same way I would when stepping out of the shower was the best course of coverage, leaving the opening to the side so that Bob could fairly easily move it to the side for the massage, and leaving only my face and arms unprotected against the bare vinyl.

Bob seemed somewhat disgruntled to discover my towel wrapping work, but she recovered quickly and signaled the second girl to come in behind her.  “Excuse me, would you mind if my friend watches me give massage to you; she is learning how to give massage and help on Saturdays.”  If I wasn’t already sure that this was going to be a hilarious experience, Bob’s question made me sure this would be a singular moment in my life.  I managed to reply that it would be fine with me, and Bob got underway, first dousing me with baby oil and then rubbing my back in such a manner that a muppet might have been more effective.  If you have ever been to a nice spa, you are enveloped in quiet, soothing music and aromatic scents of essential oils; here there was only the sound of pinball and video games across the way and the smell of baby oil and possibly cold cream that got rubbed onto my back – I couldn’t decide if I smelled more like my nine-month-old niece or my grandmother.  Bob grunted and sighed with her efforts, alternately standing on tiptoe to push limply on my back in random spots and doing deep knee bends as she released the “pressure” and let her arms slide back to a ready position.

And then it happened – karate chops!  I had to start taking deep breaths and holding them so I wouldn’t actually laugh out loud; Bob was too serious and trying too hard for me to laugh at her attempts.  After a few awkward moments of karate chopping, Bob broke out the Mr. Happy massager and began running it lightly up and down my back, which had the effect of tickling more than massaging my already tight shoulder and neck muscles.  At some point, Bob leaned over to put her face directly in front of my face and whispered, “Is my pressure okay?”  I nodded, and she peered into my face again and whispered, “Which is better, my hands or this [indicating Mr. Happy]?”  I told her it really didn’t matter, so she should do whichever was better for her.  Bob replied, “Okay.  I do both, and we will do hot towel massage, too.”  I heard some whispering in a foreign langauge before Bob told me that her friend was going to prepare the hot towels.  A few seconds later, I heard running water and the distinct sound of a microwave starting up, and I began to think, “Great, they are going to steam all of the skin off my back.”  Not even karate chops could alleviate my gnawing fear of being burned by sweet but clueless massueses.

Bob’s friend returned with the towels and there is more furious whispering before Bob pressed a tiny corner of the towel against my back and asked, “Is too hot?  I think maybe is too hot.  Maybe we wait a minute.”  I agreed with Bob, given that I couldn’t have handled the towels without pot holders based on the tiny bit that touched me.  At last, the towels were just the right temperature, and Bob laid them over my back and repeated the random grunting and pushing process.  The towels quickly cooled, so the friend was sent to reheat them while I wondered how badly I might be burned on the second attempt.  Fortunately the towels were just right, and Bob proceeded to use the towel itself to push on my back, which was surprisingly the most massage-like thing she had done.  I realized after a few short moments, however, that Bob was only using one towel, and she had left the other one lying on my rear end, which was still wearing pants that were quickly developing an awkwardly placed wet spot.  She did eventually move the towel, but I was already planning mall exit strategies that could hide my backside or snappy one-liners to explain that I had not peed myself.

Bob finally finished off with more baby oil and a final round of karate chops, and she leaned over one last time towards my face to whisper, “You all done now.  You have good time?”  Bob smiled expectantly and flashed me two thumbs up, so of course I told her I had a good time.  I did have a good time, a nice back rub, and a story I cannot repeat without laughing until I cry.