This time

I had a feeling about it. I told Jeff a couple of nights ago. I don't think it's good.

He told me not to worry, we've had these little scares before. Don't you remember when we saw Dr. Moon? That turned out to be nothing. Maybe it's nothing again.

Maybe, I said.

But I sensed it, in the way my body felt less weighted and more alert, as if I had taken claritin for head to toe.

In the morning, I called the doctor's office. They asked if I could come in that morning, but having a brief to finish, I made the first available appointment for the morning after.

Then I went about the day as any other. I bounced along to circus music with little T as he played and replayed the ball popper we had recently purchased for him. I clapped along with him each time he applauded after feeding himself a spoonful of apple sauce. And cautioned him with my no, no, no's after he tried to mount Sherlock reclining in the sun.

When little T went down for his nap, I scrambled to finish my brief and prepare it for filing. In 45 minutes, I was done, just as little T screamed awake from his bedroom. It is always the days when I need him to nap when he naps the least.

After, we trudged over to the post office and stood in a line that stretched out the door to mail my brief to the Court and the service copy to opposing counsel. In that time, I chatted with a lady who was expecting her four grandchildren for Christmas as little T prattled away to a girl waiting in line behind us with her mother.

From there, we headed to Pho Time, where I ordered a seafood pho and little T waved at all customers who walked past our table. While I sat, I felt the little rumblings in my belly -- a slight tightness with a sense of bloating. And I wondered, but tried not to. I told myself it was only because I was focused on it so much that it felt different.

When we returned home, I wondered why my belly felt flatter than it had a few days ago. Maybe just my imagination. Maybe.

When I went to bed, I hoped that I wouldn't start cramping. I fell asleep in fetal position, cradling my belly, protecting it from some unknown force.

In the morning, Jeff asked me, how are you feeling?

No cramps, so maybe it's ok?

But when I went to pee, I knew. It was not ok. And after I showered and put on my make-up, I went back to bed and let Jeff hold me.

So we went through the routine again. Going to the doctor's office to be told what we already knew. I told the ultrasound technician -- apologetically as if I were wasting her time.

Well, let's see how it looks in there, she responded.

And the few seconds of searching, searching for that faint bleep on the gray screen -- the faint bleep we had seen just ten days earlier. As she moved the device over my belly, the image of the baby appeared -- the fuzzy head, the glob of torso and limbs. Still in there, in tact. As if it were still alive.

Seeing the little body made me break down, even though I had not planned to. I had planned to be ok this time.

And I was ok -- more ok than I had been before. Because this time, we came home to little T, who now waddles all over our house, opening this door and that. Who makes baby signs of the elephant, crocodile, and monkey. And asks for all sorts of food with grunts and little fingers. And plants big open mouth kisses on our cheeks, our foreheads, our noses, wherever his mouth happens to land.

For the past couple of days, I've had fleeting moments of resentment. Why can't I have it easy for a change? Why does it have to be some god damn trial each time? Why do some women just breeze though, but I have to have the worst always befall us?

But then I caught myself. It hasn't always been the worst. We have little T, and that wasn't the worst. By any measure. And seeing him waddle around makes me realize how much of a miracle he is. Me, with my decrepit eggs, being lucky enough to have landed at least one good one, one good enough to produce a perfect little being like him.

Jeff and I talked about how we would be ok without another. With just little T. How he fills us each day with so much pride, wonder, love, and a bunch of other feelings that have no name but cram our chests up to our necks.

As Jeff trailed behind little T as he picked up this and that in our walk-in closet, Jeff said, "Oh, little T, do you know how happy you make mommy and daddy? Do you know how much we love you?" And I thought about all the people who grow up in this world questioning the extent of their parents' love, and I wondered how that is possible. How is it possible to be a parent and not express the love you have for your child on a daily basis? Do people stop expressing their love for their children when they turn surly twelve? Do parents run out of time to hug their children and cover them with kisses when they have more than one child? What happens out there that so many children grow up yearning for their parents' love?

My D&C is scheduled for tomorrow morning. We plan to wake up at 5:15 to leave the house by 5:45 to get to the hospital by 6:30 for the 8:30 procedure. What a pain in the ass. If someone can come up with a procedure to sort out the bad eggs from the good, I'm sure he'll have investors lined up out the door. I guess at some point, I'll be too old to even worry about whether I have any good eggs left. And then I'll have to reserve all my smothering kisses for little T, who I'm sure will be perfectly grossed out by my behavior when he enters his teens. But there are worse things in life, right?

Miscarriage Survey

If you have miscarried in the past six months, please take this survey being conducted by Lisa Rosenzweig, a doctoral student at Columbia University. This survey is designed to help medical and mental health professionals provide better support to women who have miscarried. I feel that miscarriages are far too often treated as non-events, and attitudes need to change. This can make a difference.

Thanks to Lisa for tackling this issue. Please see the intro from Lisa below.

(If the link above does not work, please cut and past this url:
https://www.surveymonkey.com/s.aspx?sm=VCaiTA9Wo6w60W8HA0QxSA_3d_3d)

* * *
Everyone has a unique experience with miscarriage and many find help and support through websites like this one. Unfortunately, little is known about women's experiences of support and how this may affect responses to miscarriage, and so I invite you to participate in my dissertation research study examining women’s experiences following a miscarriage. Although there is no direct benefit to you, survey results may help healthcare providers better understand and meet the needs of women following miscarriage. This online survey takes approximately 15-20 minutes and is open to women who have miscarried a wanted pregnancy in the previous 6 months who are 18 years of age or older, living in the United States, and involved in a relationship with a significant other. Participants are eligible for a raffle for a $50 American Express gift certificate. For more information, please don't hesitate to contact me.

Lisa Rosenzweig
Teachers College
lsr2106@columbia.edu

Ambiguities

I thought about following social convention and keeping the news to myself until it is "safe" to announce the pregnancy. In some ways, keeping the pregnancy secret until the second trimester makes sense. A new birth is supposed to be the one of the happiest of occasions, and who wants to taint it with the risk of miscarriage? It is a bit awkward (as I have found out) to announce in one big blur, "So... I'm pregnant, but we just don't know what will happen and miscarriages are so common and I have about a 30% chance of another one so let's just see what happens and please keep your fingers crossed for us." And what if you do miscarry? Wouldn't it be awkward to have to go back and un-announce your pregnancy? In the days following my miscarriages, I found myself emailing friends instead of calling them because I found it difficult to talk about it without breaking down.

I've never been good at lying though. I give myself away. And when you've already had two miscarriages and all your friends know you're trying again, it's difficult to dodge the question, "Are you pregnant?" My friends ask me that question as soon as I decline a glass of wine. Instead of hemming and hawing, I find it easier to answer truthfully. Sometimes, the answer is, "Nope, but we're trying." Other times, it's, "We are!" followed by a series of disclaimers.

Even the first time around, I found it necessary to talk about my pregnancy early on, especially with other women who had gone through pregnancies. I had a lot of questions. First, I needed recommendations on the books I should read. Then, I wanted to discuss the advice in the books. (Do you think I really can't have prosciutto for nine months? I keep reading conflicting advice about air travel. What did you do?) Then I had questions about whether we should opt for CVS or amnio, where I should buy maternity clothes, when I should start looking into the maternity leave policy, etc., etc., etc.

But talking comes with a price, as I found out. Last time, when I told someone I miscarried, he responded, "You shouldn't have announced the pregnancy so early." I felt rebuked for a second, and then that sense of shame quickly turned to indignation. I thought, do you really think this is about your discomfort? Another time, I felt pretty small when a friend made a point to tell me that his wife kept her pregnancy secret until her fifth month. Is it a matter of my character? Am I the loud mouth who lacks the patience and the discipline to keep it to myself for just a few months?

Maybe it's that of kind attitude that drives women to hide their pregnancies in the first trimester. I've been in situations where women lie about their pregnancy, even as they are suddenly declining food they seemed to relish before. The red flag is a "no thanks" to wine and then another "no thanks" when I offer them a taste of my tuna tartar or caesar salad. Or suddenly requesting decaffeinated coffee after grilling the barrista about the de-caffeinating process. I usually ask straight out, "Are you pregnant?" And some women mouth, "Oh, no," even as they avert my eyes, their cheeks flush, and we quickly change the conversation to the latest news topic or gossip as we both feel embarrassed to be caught in a charade. Surely enough, the "announcement" comes a few weeks later. I feel a little taken aback, and a part of me feels as if something has been betrayed between us.

I can't help but wonder if silence during early pregnancy is a residue of the days (or maybe we're still mired in it) when a woman's social value is derived from her fertility. Maybe some women who miscarry see the miscarriage as failures on their parts - even among women who have degrees and work experience to attest to their ambitions, who see themselves as independent and progressive, who don't bank their identities solely on motherhood. I've seen these women whisper about their miscarriages and then ask me not to mention it to anyone else. It is enshrouded in a quiet shame, a stigma best kept secret.

I wonder if this secrecy doesn't cheat us. It feels like wearing a burka, hiding from society an ambiguous and complicated issue - like female sexuality - that should be socially addressed. In the case of pregnancy and miscarriage, many women seem to have tacitly agreed that these issues do not deserve room for discussion in the social arena. The truth is, life is ambiguous. Every pregnancy comes with the possibility of miscarriage, still birth, complications during delivery, or post-partum problems. Instead of acknowledging these openly, we seem to prefer to pretend that the baby does not exist until the second trimester and then suddenly all is well once we pass the CVS mark. And when the miscarriage occurs or we find ourselves facing a still birth or a death during delivery, we find ourselves alone, feeling like a social anomaly and a failure. I would prefer not to find myself in that kind of a hole if something goes awry again.

The strange thing is that we have come from a time when it was common for both the woman and the baby to die during childbirth to a time when it is almost completely safe. Maybe the denial of death and ambiguity is a safeguard against the fears that permeate in the face of possible risks. If I could help it, I would create a little space for some ambiguity. For society to understand that when a woman announces her pregnancy, that is not the outcome. It is the beginning of nine months of waiting, hoping, and safeguarding. And that the body is complicated and still mysterious in many ways, with no promise of certainty. That even if this fetus is not visible on the surface and may never see the light of day, it still exists inside me. And that is a miracle.

Miscarriage Tests

For all who are dealing with miscarriage issues, I am posting a list of all of the tests I've gone through. This may provide a starting point for your own checklist if you have to go through this unfortunate testing. (Please note that the descriptions were cut and pasted from pregnancy websites, mainly www.sharedjourney.com. I can't vouch for the accuracy of the information and I have no medical expertise. Please confer with your doctor about the specifics.)

If anyone out there has been through any miscarriage tests that are not listed here, I would love to hear from you.

1. Chromosomal Defect with Fetus: Fetal Karyotype

To determine if the miscarriage was due to a chromosomal abnormality, the doctor sends the fetal tissue to a lab after D&C.

2. Chromosomal Problem with Parents

Blood test of parents to determine if either parent has genetic problems that can lead to miscarriages.

3. Structural Problem with Uterus

Scarring or fibroids growing within the uterus can sometimes interfere with implantation and the embryo’s blood supply. For the hysteroscopy, the doctor fills the uterus with saline and inserts a thin telescope into the uterus to examine it.

4. Blood Clotting Related Tests (all tested with a simple blood test)

a. Anti-Cardiolipin Antibodies

Cardiolipin antibodies are proteins found in your body that work against cardiolipin. Cardiolipin is a molecule found in your blood platelets and various cell membranes. It is one of a group of molecules called phospholipids. You need cardiolipin in order to help regulate blood clotting throughout your body. Sometimes though, your body can mistake cardiolipin for an attacking substance. As a result, your body creates soldier-like molecules to fight against the cardiolipin.

b. Anti-Phospholipid Antibodies

Antibodies are special cells that are supposed to help our bodies attack foreign invaders, like bacteria from colds and infections. Sometimes though, the body mistakes its own cells for invaders and attacks them, causing a host of problems. This is the case with antiphospholipid antibodies - they attack our own cells.

Antiphospholipid antibodies are proteins that circulate around in the bloodstream. These proteins bind to cell membranes, making them sticky. This prevents our blood from flowing properly, resulting in blood clots. These antibodies can endanger the health of both you or your baby.

c. Lupus Anticoagulant

This is a protein in your blood that causes it to clot in your bloodstream and veins differently than it normally would. Women with large amounts of lupus anticoagulant in their blood often suffer from blood clots in their placentas.

d. Anti-Thrombin III Deficiency

Antithrombin III (AT-III) is a protein made in the liver. It inhibits coagulation and limits the forming of blood clots.

A shortage of AT-III affects the normal process of coagulation and can lead to excessive blood clotting. There are two categories of AT-III deficiency. Patients with Type I deficiency have reduced amounts of AT-III protein and functional activity, while patients with Types II and III deficiency have normal protein levels, but some of it does not function properly.

Antithrombin-III deficiency can cause or lead to thrombosis, a clot forming in a blood vessel. If a clot attached to a blood vessel wall breaks loose and travels in the bloodstream, it is called an embolus. An embolus that reaches a blood vessel in the lungs is called a pulmonary embolism. This type of clot can block the blood vessel, cut off the oxygen supply to the lung tissue, and, in some cases, cause death.

e. Protein C Deficiency

Protein C deficiency is one of a number of inherited coagulation disorders resulting in a hypercoagulable state known as thrombophilia. Recent advances in genetics and biochemistry have allowed us to identify numerous coagulation defects, each having the common result of thrombosis. Examples of such deficiency disorders include abnormalities of factor V Leiden, factor XII, three chains of fibrinogen, heparin cofactor II, plasminogen, protein C, protein S, and thrombomodulin.

f. Protein S Deficiency

Protein S deficiency is a genetic trait that predisposes one to the formation of venous clots.

g. Factor V Leiden Mutation

Factor V Leiden thrombophilia is an inherited disorder of blood clotting. Factor V Leiden is the name of a specific mutation that results in thrombophilia, or an increased tendency to form abnormal blood clots in blood vessels.

h. Factor II (Prothrombin) Mutation

A specific change in the genetic code causes the body to produce too much of the prothrombin protein. Having too much prothrombin makes the blood more likely to clot.

i. MTHFR Mutation/Hyper-Homocysteinemia

MTHFR stands for Methylenetetrahydrofolate Reductase. It is a type of gene mutation that impairs the body's ability to absorb folic acid, and some studies have associated MTHFR gene mutations with increased risk of miscarriages (but other studies have found no link).

5. Tests for Potential Hormonal Problems (all tested by simple blood test)

a. Progesterone Level

Progesterone is a female hormone produced by the ovaries. It plays a vital role in both ovulation and pregnancy. After an egg is released from your ovaries, the remaining follicle becomes the corpus luteum. The corpus luteum secretes estrogen which, in turn, produces progesterone. This progesterone softens your uterine lining, helping with implantation.

b. Follicle Stimulating Hormone (FSH)

FSH is one of a number of hormones that is secreted by your brain. Inside your brain, located just at the base of your neck, there is a tiny region called the pituitary gland. This gland is responsible for releasing a variety of different hormones, including FSH. FSH hormone is used to help encourage the growth of eggs in women and sperm in men.

If you are having troubles conceiving, your health care provider will try to analyze your ovarian reserve. Your ovarian reserve refers to the number of eggs that you have available for fertilization. A high ovarian reserve usually indicates a good number of viable eggs present in your ovaries. A low ovarian reserve may indicate that you have fewer available eggs. In order to test ovarian reserve, many health care professionals rely on measurements of your FSH. Levels of this hormone directly correlate to the number of eggs that you have "on reserve" in your ovaries.

c. Estradiol

Estradiol is a type of estrogen, which is the major female reproductive hormone. Estradiol is the primary type of estrogen, and it is produced in your ovaries. As they grow and develop, your egg follicles secrete estradiol, helping to trigger the rest of the reproductive cycle.

The estradiol test is a diagnostic procedure used to measure the levels of estradiol in your blood stream. It is performed in conjuction with the Day 3 FSH test. A simple blood test, the estradiol test is performed in order to determine a woman's ovarian reserve. It is also performed in order to confirm a woman's FSH test

d. Prolactin

Prolactin is a chemical that is secreted by your pituitary gland. This is the pea-sized gland found in the middle of your brain, which is responsible for triggering many of your body's processes. Prolactin is found in both men and women and is released at various times throughout the day and night. Prolactin is generally released in order to stimulate milk production in pregnant women. It also enlarges a woman's mammary glands in order to allow her to prepare for breastfeeding.

Prolactin inhibits two hormones necessary to your ovulation: follicle stimulating hormone (FSH) and gonadotropin releasing hormone (GnRH). Both of these hormones are responsible for helping your eggs to develop and mature in the ovaries, so that they can be released during ovulation. When you have excess prolactin in your bloodstream, ovulation is not triggered, and you will be unable to become pregnant. Prolactin may also affect your menstrual cycle and the regularity of your periods.

Normal prolactin levels in women are somewhere between 30 and 600 mIU/I. If your levels measure towards the high end of this spectrum or above, you may be suffering from a prolactin irregularity.

e. Thyroid Stimulating Hormone (TSH)

There are two main types of thyroid problems that can affect fertility:

* Hyperthyroidism (over-active thyroid): hyperthyroidism is often hereditary. Symptoms include fatigue, increased heart rate, weight loss and light or absent periods. It occurs most frequently in menopausal women. Its impacts include an increased risk of miscarriage. Treatment options include drugs, radioactive therapy and surgery.

* Hypothyroidism (under-active thyroid): hypothyroidism is also usually hereditary. Its symptoms include fatigue, lack of concentration, muscle aches, constipation, weight gain, very long menstrual cycles and heavy periods. In some people the thyroid gland (which is in the throat in front of the windpipe) may be enlarged. Treatment will be lifelong and takes the form of thyroxine tablets, with a likely increased dose during pregnancy.
(from http://www.gettingpregnant.co.uk/glossary.htm)

A Form of Relief

Sometimes when I pick up Sherlock's poop, a part of me is relieved when it's the firm, relatively dry, well-constituted kind, even though it feels disturbingly warm through the plastic bag, and not the runny (and yet, not runny enough) mush that forces me to evaluate the boundary of my duties as a good citizen to clean up after him. So that's how it felt when I learned that our last baby had trisomy 21 and would have had Down's Syndrome had I carried him to term. (And yes, it was a boy.) A part of me was relieved that we weren't forced to make a decision that no couple would ever want to make, even as we demand the right to make the decision in the first place. Another part of me was relieved that the baby was inherently defective, that it wasn't my body that caused the demise, even though my body created his chromosomal defect in the first place.

These are funny forms of relief, when something so shitty comes with a discount tag and a reminder that it could have been so much worse.

Biding Time

I tell myself that I don't want to become one of these women who do nothing but obssess about having a child, but I feel like I'm turning into one of them. It doesn't help that I'm not working right now. My contract job ended several weeks ago, which seemed perfectly fine when I was pregnant and felt both a sense of purpose and the value of my limited free time. Now, my free time stretches out indefinitely. Having too much time to think feels a little suffocating at the moment. So, I've been desperately scouring the web for a part time job to keep me somewhat busy while I continue working on my writing. And the economy flicks me a finger and says, bad timing, lady. Frankly, I wouldn't mind working at a Starbucks right now (if they're even hiring), but working as a barrista probably isn't the most constructive use of my time in the long run. Not to say that I look down on it because I would do it in a heartbeat if we needed the money.

So I'm trying to recall those days when I worked 6am to midnight and whined about wanting more free time. And dreamed of taking classes, throwing pottery, gardening, volunteering, reading, writing. I'm trying to get to a point emotionally where I can focus on my writing projects, get interested in reading about subjects other than miscarriage, where I can stave off the sense of depression that weighs me down, keeps me in bed in the morning, and questions what is the point of all this. And when a friend calls for lunch, I drag myself off to meet up with her, somewhat reluctant to go but grateful for the fishline.

I'm trying to keep it all in perspective. I know how lucky I am in so many respects compared to so many others. And I know that having this time is a tremendous privilege - and can be extremely fruitful if I can force myself to focus. And that two miscarriages is not the end of the road. Compared to what some of my friends are going through, these are just small bleeps. So I plug in my ipod, get into my jogging gear, and drag myself to the gym. I prepare my to do list for the day. I research my writing subject. I send out emails to people to propose ideas and solicit advice. I try to put my thoughts to paper. I take the dog for a walk. And before I know it, it is already evening.

And then, only then, do I look at my google calendar, count how many days it has been since my miscarriage, project how much longer until we can try again, and start to hope for another beginning.

Healing

There are some things that have the power to heal.

Like watching Sherlock romp through the doggie playground, chasing the green soft plastic ball with the dedication of a professional athlete, before he crashes into the wire mesh fence like a right fielder flying for the ball;

Fighting with the shells of a dungeness crab with all of my fingers dripping with garlic butter and then slurping up a forkful of garlic noodles as we banter about the election, Thanksgiving, the health risks of eating chicken skin;

Standing above the butternut squash and sweet potato soup, stirring, tasting, and stirring some more, as I strive for perfect spoonfuls that will feed our family;

Feeling the fleshy softness of Jeff's fingers each time he reaches across to hold my hand;

Reading my book under the warmth of Sherlock's body draped across my lap;

Seeing a new bloom on my fuchsia.

I gather these moments and place them side by side. As surely as there are broken days, there are moments like these, filled with life, shaped by happiness. With these moments, I build a giant band-aid to wrap around me, to give me space to heal.

Crevices

I spent most of last week trying not to fall into a crevice. You know, those little cracks that can suck you up and swallow you whole. Funny how you can go for months never noticing them but then all of a sudden, they seem to be everywhere when you find yourself feeling rather small. Like the tiny green baby shoe that someone had dropped in the middle of the sidewalk. Or at the doctor's waiting room where I found myself surrounded by pregnant ladies in chirpy excitement over their due dates. Or in my backyard where I found my blood colored camellia dead surrounded by thriving giant weeds sucking up whatever energy the sun had to emit. I don't want to ponder the meaning of life or death or its cruel irony. Not this week. I don't want to get stuck in these little moments that can swirl into a giant vortex of meaning.

I want to tread lightly over the tricky letters in the word miscarriage, especially the concave c with its wide open mouth and the slippery g that winds around itself like a little maze. I want to fly over the loopy s's in loss even as I find myself curled up like one giant s on my bed with my legs bent at the knees and my head curled into my chest. And avoid slipping down the diagonal of the y in baby and getting stuck at the bottom with no way to climb back up. I want to bounce off of these letters so that I can find my way to the next word and then the next, past the punctuations and the spaces, and eventually onto the next sentence and then the next paragraph.

This is my life unfolding, page by page. And I tell myself not to get stuck here. I need to refocus my lens, gain some distance, so that I can see past these few words, these few sentences. I have to find my way onto the next page, the next chapter. I want to end up ensconced in the warm embrace of o in love, buoyed by the peppy p's in happiness, and resigned to the decisive t in fate.

Miscarriage of Silence

I reject silence because silence is not for me.

Silence is for the criminal in hand cuffs who has something to hide.

Silence is for Charlie Chaplain who danced with the world that laughed with him.

Silence is for the adulterer who hangs her head in shame for stealing the life of another.

Silence is for the Buddhist monk in meditation who empties his heart and mind by choice.

Silence is for the lambs as they wait to be slaughtered.

Silence is for the dead.

Silence was not for my friend Jemma's mother who screamed and clung to the coffin as her daughter was lowered into the grave.

Silence was not for my mother who wailed with the cry of an animal I had never before heard when she learned of her mother's death.

Silence is not for the angry who take to the streets in protest for the deaths of innocents.

Silence is not for those who feel cheated and seek to reclaim what was lost.

Silence is not for the heartbroken.

I want the world to know how I cry for my lost baby.

Silence is not for me.

My Bruise

There is a bruise on my right arm. It is a black, brown, purple oval, yellowing along the edge, about an inch and a half long, half an inch wide, in the inner part of the arm just below where the elbow bends.

I saw it the other morning in the shower as I was washing myself of what does not belong, what is not a part of my body. There it was, a smudge of something that did not belong but would not wash off.

It is there where the doctor had inserted the needle. After the greeting, after the droopy eyes to express her sympathy, after the warm touch of her hand, after the tears. After we made some jokes because that is all we had, likening it to two glasses of martini. After the injection, she had me lie on the table, feet in the stirrups, bottom all the way down to the edge. As my head dropped, I felt the drug ride through me, soothing and numbing, and I gave in without resistance.

And I lay there, staring at the ceiling where little cut out women dangled in the air, pretending I was drunk on fancy martinis without olives, as the noise of the suction whirled around in my ears. Out of the corner of my eye, I saw the nurse dangle some tissue, bloody and wet and glistening under the florescent light, before dropping it in a test tube, and I tightened my grip on Jeff's hand.

Later, I staggered out of that room, not only drunk on the injection but weighted down by the pain of the cramps, even though I was leaving lighter than when I had entered. We went home where I lay in bed, clutching my stomach, smelling my own smell from the night before.

Today, I find myself looking at my bruise, touching it. It provides a strange comfort. It is the only thing that remains after the process of removal.

Quagmire

I am pruning the over grown tree in front of our house. It has been two years since I took the time to tend to it. During that time, I have seen its gaunt branches threaten to take over the sidewalk, slap the faces of unsuspecting pedestrians, and lurk over fragile windows of innocently parked cars. Today, I go at it with my lopping shears in hand, forcefully severing its limbs with broad swaths, watching the flutter of leaves as they dive to the ground, hearing the heavy fall of its parts. And I find myself wondering, why this sudden enthusiasm? Why today? Why am I so eager to cut through this life?

I sit with my laptop on my lap. I click impatiently, scanning the page for some magic words I have not yet identified, before moving onto the next link to begin scanning again. There are so many stories, so many women, so many lost children. I leave little notes here and there, desperate to connect, secretly begging for sympathy. When I look up, it's already noon. How could that be?

I run into an acquaintance I hadn't seen for months. I scrutinize her smiling face, wondering if I should say something or stay with the small talk. In the middle of Market Street with the buzz of cable cars and buses and pedestrians. When people are already starting to prepare for the holidays, and tourists bounce past the stores with maps and shopping bags in hand. And in my baggy green camouflage pants, raggedy fleece with a hole on the left sleeve, nondescript black shirt, I'm dressed as if I have disappeared, as if I no longer exist. I wonder if she wonders where I have gone, if I am lost.

I don't want this to be my life. Not the whole of it. I want to move on, not get stuck here. Please, not for too long...

Nourishment

I don't want to wallow. So I turn to anger, that all too easily accessible, less than authentic, wonder bread of emotions.

On Friday, I found myself on the couch, clutching Darci Klein's To Full Term until I had turned the last page. It is the story of a mother who, after having a daughter prematurely at 28 weeks, suffers two subsequent miscarriages and then goes onto another pregnancy with twins. At 20 weeks, the twin boy's sac ruptures and she is faced with the impossible choice of having to agree to abort both twins. By the time she becomes pregnant a fifth time, she had spent an inordinate amount of time researching miscarriages and learning more about the subject than some of her doctors. By insisting that she receive the tests and care she would not otherwise have received, she saves her pregnancy and carries her baby to full term.

I read her story, and my attitude about miscarriages has changed. I have been so passive about my pregnancies, accepting what my doctor told me and just waiting to see what happens. Now I wish I had insisted on the whole set of tests after my first miscarriage and demanded additional monitoring during my second pregnancy. I accepted my doctor's cursory statement that 70% of miscarriages are caused by chromosomal abnormalities and that the causes of the remaining 30% cannot be determined. Apparently, this statistic is not correct for women in my age group. And for miscarriages that are not caused by chromosomal defects, there are a slew of tests that can be used to assess other possible causes. I know I read about the other tests after my first miscarriage, but for some reason, I focused on the language regarding chromosomal defects, possibly because I wanted to believe there was nothing that could have been done to save the baby. Now I wonder if I could have saved this baby had I insisted on testing after my first miscarriage?

So I am angry, about the poor quality of research available about miscarriages, the wait and see attitude that I had accepted for the past several months, my failure to inform myself, the unanswered questions. According to Klein, NIH spends not even 1% of its funds to research miscarriages, indicating that they treat miscarriages as inevitable conditions instead of treatable disorders. So I focus on this anger and map out a plan. Compliance and complacence will be checked at the door. I will put on my litigator hat, put skepticism and scrutiny on high alert, and filter for glib responses. I will scour the web and bookstores and squeeze whomever I can for answers.

Even with this anger, I know that I could take the entire slew of currently available tests and come up with no answers. That the tests could say nothing is wrong, even though something is obviously not right. That months and months later, we could find ourselves helpless, with not much more knowledge than we have now. And that we could find ourselves traipsing from day to day, wondering again what the hell went wrong.

But that thought is more than I can bear right now. For now, I will embrace this anger and let it nurture me and nourish the emptiness echoing throughout my body.

Not Again...

I am sad to report that I had another miscarriage yesterday. We went in for our genetic counseling and CVS and found out that the fetus did not have a heart beat when we did the ultrasound. Apparently, it stopped growing shortly after my last ultrasound when we saw the heartbeat at 9 weeks and 3 days. For the past two weeks, my placenta and ovaries continued to nurture the little thing as if it were still alive, which is why I continued to have pregnancy symptoms. At least this time, I was spared the pain of watching the life leak out of me and having to drain myself every few minutes.

So, we're back to the drawing board. I'm not sure how I'm feeling yet. A little numb still. We are planning to undergo some tests to see if they can figure out what went wrong. I'm trying not to get too discouraged because I've heard so many success stories from many of you who've had a much tougher time. So for now, I'm just going to hang in here and try not feel too sad for myself.

The Test

We're in the five day window. I checked the calendar yesterday. And the day before. I left it out by the sink last night, so that I wouldn't forget. It's what I think about as I am awakening. Entangled in my dream, a piece of driftwood in a clump of seaweed.

I'll just check, that's all. Like checking to see if we have enough milk in the fridge. Or checking the roses to see what needs pruning. Just an every day checking. Not a what if I fail the test, how could I live with myself kind of test.

Besides, I already know the answer. I was feeling a little bloated yesterday, wasn't I? And maybe a little crampy? That's a sure indication that I'm not. But what about the drowsiness? Isn't it similar to the drowsiness I felt a few months back?

I pull myself out of bed and throw out, I'm going to try the test. Oh, is it already time? Jeff asks. I think so, I respond. I thought you smelled like you're having your period, he says. And my heart drops. What if I am getting my period?

I walk down the hall, double check the box to make sure it's the kind that works five days before, and tear open the plastic wrapping. After the test, I put it on the shelf above the sink and hardly look at it as I brush my teeth. Still one horizontal bar. But it's just doing its thing. It takes a minute or two to kick in, right? I start undressing for the shower. Jeff shows up at the door. What does it say? he asks. Negative. Oh, Sweetie, he says. It's fun trying, right? And he's too quick to smile, to reassure me, to hide his own disappointment.

After the shower, I check again, in case it changed its mind. Still a negative, a clear blue negative. And I don't let my mind interrogate me. What if I am too old, what if we had our only chance, what if I took too much for granted? It's a good thing, I tell myself. If it were a positive, could I brace myself for another possible miscarriage so soon? It's better to wait. It really is. And I need more time at the gym to lose the weight that I haven't yet lost. Another month would be good for me. Really.

It now feels like a dream, those couple of months. When I walked around, wondering if everyone could see through my smile that there was life growing inside of me. When every step taken, every bite eaten, every extra minute dreamt felt like a secret ritual, a series of small celebrations.

Penumbra

She was wedged between the wall and six buxom Hawaiian dudes who obviously brought along their appetites. Once again, the hostess pushed past us, looking off into the distance, even as we reached across to tap her elbow with our excuse me's. She had told us twenty minutes over forty minutes ago, and we could taste the hamachi nigiris and the nigori sake. A table off to the far left next to the sushi bar has been vacant and uncleaned for at least fifteen minutes, and I positioned myself to intercept the hostess for her next loop. Another couple who had walked in before us stood up and left the waiting area in a huff, and I quickly eyed the emptied chair and looked over to the pregnant woman, motioning, do you want to sit? She smiled and pushed past the Hawaiian shirts. Her husband trailed behind her.

- What a wait, she said, as she smoothed down her skirt. The concierge recommended this place so we drove right over. I'm starving.

- But aren't your selections pretty limited here? I asked.

- Yeah, but my husband can't live without sushi...

I looked over at him as he gave me a what the heck shrug, and I thought of how we had avoided our favorite sushi restaurant for months until Jeff finally broke down and I dragged him over for his fix. I wondered if her husband was up to the task.

- We were here the other day, and we noticed that they have teriyaki, noodles, and things like that. I hope you find something you can eat, I said, feeling protective of her as I would toward a sister, a daughter, a friend, myself.

Her husband shuffled off to get a drink, and she yelled out for him to get her something virgin.

- We just got in from LA, and what a long flight. But it's our last vacation before the little one shows up, so...

That is what this was supposed to be for us too, I wanted to say.

- How far along are you? I asked, as Jeff pulled me in protectively and grabbed my hand to keep me from picking at my fingers.

- I'm in my seventh month. Just two more to go.

- Oh, how excited you must be...

I wanted to reach over and touch the round front of this woman I didn't know, run my hand along the taut skin to see how it felt to be pregnant so far along, and tell her that I was pregnant too until three weeks ago. But I kept my hand firmly planted in Jeff's because I didn't want to feel like that penguin in The March of the Penguins that covets the baby of another. Still, I found myself crossing my fingers and saying a silent prayer for her safe passage and leaning in closer to stand in her penumbra, as if to say, I am one of you...

Seaweed Soup

It's worse to wait. I pressed the key and heard my dad in his everyday voice.

- Yes, Dad, it's me. Yeah, everything's fine. But, Dad...the baby died. Yes, the baby died, that's what I said. The baby is dead...

(How the hell would I know the word for miscarriage in Korean?)

- No, we don't know what happened. Yes, Jeff's right here. We're just leaving the hospital. No, no, I'm not going into work today. We're going home now. Yes, we'll be ok. I'm just going to rest. Ok...

- Hi, Mom, I don't know. I don't know what happened. I know it'll be ok. We're fine. Yes, Jeff's staying home with me today.

- The doctor said we can try again in about a month, after I have my period. It's very common. I know... There isn't much to do to recover. The doctor said I just need to rest. No, she didn't say anything about a special diet.

- No, no, you don't need to come out. I'm just going to lie in bed, that's all. No, no, don't cancel your trip. You've been waiting for so long. There isn't enough time for you to come out. We'll be fine. Really. We can cook for ourselves.

- Seaweed soup? Yes, I know it's good for you. You don't have to make it for me. It's ok. Ok, I'll have some. I'm sure they have it at Korean restaurants... No, I don't know how to make it. Oh, ok, seaweed... really, you pan fry the seaweed? Yes, I have sesame oil. Ok, I'll add some clams. No, we don't have any. Yes, Jeff can get some at the store.

- Yes, I promise, I'll have some. I have to eat it every day? For a week? Ok, ok, I promise.

That night, after I deleted my calendar entries tracking my pregnancy and after I threw all the baby books into a Macy's bag and pushed it into a closet in the other bedroom, I shoved seaweed soup into my mouth, sobbing and cursing at the seaweed, cursing at my body.

Ultrasound

In the morning, we dressed for the final set of photos. It was an occasion of sorts. We didn't bother to dress up, even though it was a funeral of sorts as well. In our fleece and baggy pants, we looked like just a regular couple coming in for a regular check up. We got in the car, drove, and parked like any other day.

Smacking on her gum and swiveling back and forth in her chair, the receptionist click clacked on her keyboard with her palm tree painted finger nails after making me spell out my name twice.

- Oh? How do you spell that again? O-H, you said? I don't see no O-H in here. When'd you make your appointment?

- Just last night. I called in because I was bleeding, and the nurse on the phone told me to come in this morning at 9:45.

- Well, I don't see no O-H here. Have a seat.

We sat and we sat and we sat. After forty minutes of doctors and technicians passing back and forth in the hallway, with not even a glance in our direction, looking officious and preoccupied, a young asian woman in green garbs called my name. As she walked us to the ultrasound room, she smiled and introduced herself. And I turned to her, as if to make a confession, and burst out, I lost my baby, and my eyes exploded into tears. I presented the photo of the ultrasound we had taken just two weeks earlier, of the little creature that had a heartbeat, as if to plead my case.

She probed, and we saw the image of the empty uterus and of the void where "the gestation had taken place." Having been told what we already knew, it now became a reality because someone else now knew it to be true and told us so.

After I dressed, we slowly walked to the elevator, and with a start, I realized that we had left the photo behind. Jeff, after asking if I really wanted to keep it, ran back to get it.

While waiting for the D&C, we walked to AG Ferrari down the street for lunch but really to kill time. I ordered a prosciutto sandwich, and I bit through the focaccia, mozzarella, capers, organic greens until I reached the prosciutto and slowly clamped my teeth through the thinly sliced pieces of ham. As I chewed, I felt the prosciutto fill the crevices between my teeth and dig into my gums, and I savored each bite, seeking compensation. I wanted to load my body with all that I had foregone, as if to say, there, I am getting something out of this.

Miscarriage

The blood gushed out as if from a popped water balloon as soon as I sat on the toilet. Looking between my legs, I saw the pool of thin blood, whirling in a daze at the sudden exodus. Then I felt clumps of mass travel through my body canal and expel out of me, one... two... three, dollops of flesh, like lotto balls riding down the tube to claim someone's destiny.

After three plops, they stopped, and I looked down again, like a voyeur, repulsed yet drawn to see what it was that my body had created and destroyed. Unable to see through the murky red, I returned with a pair of wooden chopsticks left over from some take-out and crouched over the toilet. Dredging through the bowl, I fished out some tissues. I dredged and dredged again, looking for something that could resemble the fetus that no longer was, but all I saw were layers of bloody film like torn wet paper stuck to each other.

I read somewhere that it is advisable to bring in a sample of the expelled tissue for tests. With my chopsticks, I picked up a piece of the tissue, as I would a piece of sashimi, and imagined slipping it into a Ziploc sandwich bag, carefully trying not to drip on the lip and having to wipe it, sealing it tight, and carrying it in my purse to Dr. C's office. And pictured the bag puncturing, leaking out onto my wallet, keys, book, scraps of notes, and tissue, staining all I have. I let it drop back into the bowl and threw the chopsticks away. I put my hand on the lever -- and flushed, and watched it spiral out of reach.