Erstwhile Dear

I have written here before that with each pregnancy I feel a deep sisterly mourning with the others in the room: those waiting for their baby. Statisticians believe that of known pregnancies 20% end in miscarriage and that one in four women will experience one in her lifetime. And there are reasons to believe that the number is actually much higher. I am grateful for this chance to walk beside my friend Susie in her experience, as a reader, through her story.

a note of introduction from Susie (susannawales@gmail.com ): I wrote this essay about infertility and miscarriage nearly four years ago now. I was scrambling for ways to express a grief so often unnamed and to come to terms with my suffering. I sought out many books during those years, some of which were immensely helpful,  namely A Grief Observed by C.S. Lewis, Walking with God Through Pain and Suffering by Timothy Keller, and The Hardest Peace by Kara Tippetts (a new documentary about her story was just released). In my experience, the pain of miscarriage doesn’t go away, but it does dull and it does recede. Since that difficult time, I have had the joy of becoming a mother through adoption twice over to two beautiful boys: Victor is now three and Bastion is one-and-a-half years old. I have been astonished at the Lord’s faithfulness to me, and I hope that this description of my journey brings comfort to someone who has likewise suffered.

Content warning: the following beautiful and honest essay contains explicit descriptions of miscarriages. Please evaluate your emotional and mental state before reading, for example whenever pregnant I avoided stories of pregnancy and birth complications.–RR

by Susie Wales

As a newlywed back in 2012, whenever I pictured my life five, ten, or fifteen years down the road, kids were always in the frame. I am the fifth of seven children and my husband Ben is the second of five. We both wanted children and expected to be expecting by our second year of marriage. Then, a couple of months shy of our first anniversary, I miscarried at six weeks. We hadn’t even been trying to conceive but were elated nonetheless that I was pregnant. Then a few days after a blood test confirmed a positive pregnancy and my OB/GYN doctor examined and congratulated me, I miscarried at home. Almost as soon as we had time to cheer, we had lost the baby.

I sat on the toilet and bled, painfully passing bits of tissue. I turned and looked into the toilet for signs of life and scooped up a shiny translucent mass of tissue. I held it in the cupped palm of one hand and gently probed at it with my other index finger, clearing the blood away. My breath quickened. I tore a square of toilet paper from the wall and swaddled the lump of tissue in it. I stood in silence a few moments, the tiny tissue quivering in my shaking hand. Then I lowered it down into the toilet and flushed. “I think I just bled out our baby,” my voice cracked as I shared the news with Ben on the phone. Upstairs under my bed covers, I rocked from side to side and cried.

Three months later, we conceived again and the baby held on for ten weeks before passing in a rush of bright red clots that disappeared down my shower drain. Suddenly, we had bereaved the loss of two children and felt a weight we hadn’t anticipated. Having a family might not come as easily as we had planned.

Though the miscarriages were painful, we were hopeful we would conceive. After all, those pregnancies had come without strategizing, so now that we would pay closer attention, we thought we would get pregnant in no time. But after the fourth month of trying to conceive without positive results, we consulted an endocrinologist. He discovered I have a condition called Factor V Liden, so I may be prone to clotting, which would make any pregnancy more risky. I left those appointments feeling more discouraged than when I had entered. Keep having regular intercourse, he advised, and try using an ovulation predictor kit.

I hoped that each month would be the one.  After each conception window passed, I listened for my body to give me signs of life. When my breasts were sensitive and full, I wondered, “Are they getting ready to nurse a baby?” With every twinge of hunger, I hoped. Was the bloating and cramping just my body readying itself for a growing life? I flipped the calendar to the season in which I’d be nearing the end of my pregnancy and pictured fanning myself in the heat of July or bundling up mid-December. I browsed the “Names I like” document I kept on my computer.  I thought about driving to the maternity clothing store in a strip mall nearby, just to look. I dreaded using the bathroom and then sighed with relief when there were no drops of blood in the bowl.

Then month after month, the periods came. On one of those first several months, in the early morning darkness, I awoke to cramping, and stepped to the bathroom.  My bare feet recoiled when they met the cold tile floor. I eased onto the toilet, my elbows propped on my thighs, and bled. I slipped back under the comforter and buried my face in Ben’s shoulder. He stirred. “Bleeding?” he asked. “It’s…so sad,” I whispered. We repeated this refrain each month as my periods came. And each month, the dreams I had nursed over the previous two weeks dissipated like morning mist.

During my first two years of trying to conceive, it seemed every woman around me was pregnant. At that time, my two closest friends from college were each on their second babies. All five of my sisters in law had just had babies or were expecting. Ben’s friends from college—all younger than me–continued to share their joyful news. Genuinely excited at first, I soon succumbed to self-pity and jealousy.

I felt a dissonance with my body that I hadn’t previously experienced. I have nurtured children most of my life through babysitting, teaching, being an aunt–yet when I wanted to carry my own children, my body seemed to be stopping me. I stood at my bathroom mirror with my hands pressed on either side of the sink and asked my red-eyed reflection, “What is wrong with you?”

During the summer of that second year of trying to conceive, we moved from Virginia to Michigan and started with a new fertility center. After tests ruled out endometriosis, the doctor prescribed timed intercourse and ovulation predictor kits. Back to that familiar recipe: we tried for a few months to no avail. With the new year came a greater sense of urgency and we moved to the next level of treatment. We were introduced to Intrauterine Insemination (IUI). This procedure increases the odds of conception as a doctor places the male’s sperm deep inside the female’s uterus where it will have higher chances of forming an embryo. We were optimistic.

Then after six straight months of failed treatments, we decided to stop and try on our own again. These treatments were getting costly and my heart ached with each disappointment. We took a break from intervention and hoped for a natural conception.

Then six months later, amidst the bustle of Christmas excitement, I realized I was a few days past my monthly period. The next morning I took a pregnancy test and blinked at the two strips on the test: positive. I clapped my hand over my mouth and rushed to call Ben with the news. Could we really be pregnant? I knew I should be cautious, but my giddiness over seeing a positive after years of negatives cast a hopeful spell over my doubts.

For the next month I gave myself shots of blood thinner into the pinched flesh of my stomach each night. The doctor prescribed these Lovenox shots to keep my Factor V Liden blood clotting in check. Each night I ripped open an alcohol swab, rubbed it over my belly, breathed deeply, put in the needle, pressed the plunger down, and pulled the needle out. I had a cold wash cloth ready to apply and gently press over the spot of injection that stung and burned for a minute or so. It took some practice, but after a couple of weeks, I got through the whole routine without stalling. I took five deep breaths and cheered myself on:  “Ok, it’s ok, everything’s ok, you can do it.” It usually took between one and five minutes to gather the nerve and then it was over. It may not be easy, but this pregnancy was progressing, hope was growing.

Two days after my eight week ultrasound, I traveled with Ben to Ohio where he was slated to work a trade show for his company, which sells flavors to the food and beverage industry. We drove five hours to our hotel, wheeled suitcases to our room and Ben eased onto the bed while I headed to the bathroom. When I went to flush the toilet, I noticed three little red drops in the bowl. My chest tightened. I flushed and stepped out to tell Ben I was spotting. While passing bits of blood is fairly normal during the first trimester, I knew that for me, it always preceded a miscarriage. We sat together on the bed, wordless.

The next morning I felt optimistic. I used the toilet and it was blood free when I flushed. After dropping Ben off at his convention center, I drove to a library a few miles away. I arrived about twenty minutes before it opened, parked my car, and dialed my fertility doctor. My shoulders immediately relaxed when I heard the warm, reassuring voice on the other end, “Spotting is very common at the point in your pregnancy.” She said not to worry and planned to see me first thing Monday morning to make sure everything was ok. I smiled into my phone, relieved.

In the library, I found an empty table next to large bay windows that cast squares of light onto the carpet. I set up my laptop and opened up an essay for an MFA program for which I was applying. The essay was about infertility and the despair I felt because of it.  Even though I had spotted the night before, I decided to replay the doctor’s calm words in my ears “this is very normal.” It had been a few months since I’d opened this particular essay about grief and loss. Newly pregnant, I felt I was looking back at the tear-filled writer with compassion. I wanted to offer her the same reassuring voice I’d just heard on the phone and soothe her fears. Although I knew miscarriages usually occur within the first trimester, I was already beginning to feel that this pregnancy was different, spotting and all. We had tried for so long for this one, I thought, this baby will come. I think it’s a boy.

It was after lunch while I was sitting in the children’s section of the library when a sudden a pain shot through my lower back. I slipped my laptop into my backpack, slung one strap on my shoulder and hurried to a large, one-stall bathroom at the back of the library. I sat down on the toilet and began bleeding profusely. Large clots came fast. I felt myself lift up and detach, floating above in the ceiling watching myself. I didn’t cry, I didn’t even whimper. I pushed my fingers hard against my tailbone as each rush of blood and tissue came.  I leaned forward and then sat upright, rocking slowly back and forth, back and forth. I pressed fingertips to my temples and breathed. When there was a break in the bleeding, I pulled toilet paper from the wall, winding it around one hand so that it looked mummified. Then I stood and stuffed the toilet paper between my legs to catch any blood. I reached up to flush the toilet – now piled with clots. I reached my hand up to pull the lever when something made me hesitate. I reached into the toilet bowl, grabbed an in-tact mass of tissue. It glistened and quivered, sliding through my fingers. I gently laid it down on the floor.

I stared at the mass of blood and started to shake. It wasn’t just a lump of crimson tissue. It was my boy’s broken body. I could cradle him in my hands, walk back through the library, out to the withered flower garden by the parking lot, dig up the cold earth and bury him there. I could kneel at his grave and weep. But I couldn’t leave the bathroom with him, not with my body bleeding and my pants around my ankles. What could I do? My phone – where’s my phone? I fumbled through the pockets of my back pack with my one clean hand, grabbed my phone and took a picture of the mass on the floor. You couldn’t tell how big it was so I placed one hand, palm down, on the tile floor next to it. There was no open casket, no eulogy, but at least I had captured physical proof of my baby’s life. Ultrasounds had showed black and white pictures of his tiny frame, but here I held his bleeding body in my own hand. I scooped it up, released it into the toilet, and began to mop up the floor with toilet paper. I kept filling the toilet with bloody toilet paper and flushing and flushing it.

Tears blurred my vision now; they slipped off my chin, into my ears, down my neck. Snot covered my lips. I ran the faucet over my hands until the water ran clear, digging blood from under my fingernails until my finger pads started to prune. My eyes were stinging now. I raised a shoulder to wipe my nose again and again. I tugged my tight jeans back on and with trembling fingers pulled at the zipper on my coat. I stared at the ceiling, at my sobbing reflection in the mirror. I had returned to myself. I pressed the hot sides of my face and took deep breaths. I was going to have to exit the bathroom, wind my way through the library, and drive the ten miles to the convention center and tell Ben what was happening. I was going to need to keep my composure.

I sat in my parked car at the convention center a few minutes, wiping my nose, then made my way to Ben’s booth. I wound around tables with samples of candy, slushy machines whirling blue raspberry splurpies in circles, and self-serve ice cream machines. It smelled like a carnival and it made me want to vomit. I walk slowly up to Ben and breathed the news in his ear. His face fell and his eyes reddened, “I’m so sorry,” he whispered. We stared at each other for a long moment, then my eyes began to burn.  I retreated to the hotel bathroom stall and bled – the clots coming in waves. My body was more in shock than in pain, frozen under the spell of a trauma it was enduring for the third time.

Half an hour later, we started the five-hour trip home. We stopped at a rest area when the blood was soaking through everything and wouldn’t stop. I waddled up to the front doors of the little building, one hand wedged between my legs. I eased onto the toilet, my elbows jabbed into my knees, and held my weary head in my hands.  I released a few more clots and felt some relief. When I stood up, my head swam. I had felt this before—I was about to faint. I whispered through dry lips, “Ben! Ben, Ben, I need help.” I crawled on my hands and knees out of the stall and around the corner towards the door. I summoned a louder voice now, “Ben! I need help!” I clawed at the swinging door and managed to pull it open enough for Ben to hear me where he was waiting in the lobby outside. I fell to the floor, my head thudded onto the tile.

I was lying on my back in the middle of the lobby. It was late, pitch black outside the rest area. No one else was there. Ben peppered me with questions: “Susie, can you hear me? Susie, where are we? Susie! SUSIE!” He was loud and demanding. I shook my head from side to side, mumbling assents. He carried me to the car, laid me in the passenger seat, reached in the backseat and ripped open a plastic container of gummy bears he had picked up at the trade show. “We’re going to get you to a doctor. Keep eating these. We’ve got to get your blood sugar up,” he said as he started the car. I smacked my lips hungrily, chewing and swallowing one gummy bear after the other, relishing the rush of energy, my lips sticky. “Susie, what are you eating?” Ben asked, making sure I was conscious. “Gummy bears,” I said, and smiled despite myself. They tasted so good.

My head throbbed and I still felt light headed but I was coming back to myself as we headed towards an urgent care center about twenty minutes from the rest area. Ben decided to call his parents to let them know what was happening. I heard a couple of faint rings and then his mom picked up, “Hello?” “Hi Mom,” he said. “I want to let you know we lost our baby.” His face twitched. There was silence on the other end at first and then a sigh and moan of, “I’m sorry.” He explained that I was bleeding a lot and we were on our way to the hospital. There was no need to come, we just wanted to let them know. Hearing Ben talk on the phone was like a flashlight piercing the fog. I had spent the last few hours in a haze of shock and now I was feeling the reality: I had miscarried again. It both pained and comforted me to hear him state it so plainly. And I realized in that moment after he hung up the phone, as he stared ahead with his hands gripping the steering wheel, that it was not only my loss but his too.

We reached the urgent care center and Ben carried me in, my legs bouncing as he jogged inside. Someone brought me a wheelchair and pushed me down the hall to a room. I was fully conscious now, and I was exhausted. A nurse put an IV in my arm to hydrate me. I could feel something cold trickle down my arm, then slowly the headache I had the last couple of hours began to subside.

A nurse rolled my bed down the hall to the OBGYN unit and parked me next to the ultrasound machine. Her job was to make sure all of the tissue had been expelled from my uterus during my miscarriage. She stuck a condom-covered, gel-topped plastic wand inside me. My body flinched under the sudden pressure and then relaxed as much as it could as she rolled the wand around my uterus, probing for scraps of the baby I had lost. It felt like an intrusion into a private place, like a cocoon was being torn open and scavenged. She peered into her computer screen and I turned my head to see the grainy, black void.

I had had two ultrasounds in this pregnancy so far—the first was at six weeks. My younger sister was in town and she went to the appointment with me. A large-screened television monitor on the wall across from me showed a blurry, bean-shaped fetus. After the doctor printed and handed me a glossy ultrasound strip, my sister took a picture of me as I pinched the shiny photos, holding them in front of my chest. Later that night I had held a vase of fresh flowers Ben bought me and he snapped a photo—life was blooming inside of me! The next ultrasound was at eight weeks: everything looked normal, the baby was growing on schedule, and its heart was pulsing with life.

Just hours earlier, I had held not an ultrasound strip but the substance of those pictures, the blood and tissue that would later be my baby. I had taken pictures of this lost baby. Now faced with an empty ultrasound image, these evidences became even more important to me.  I wasn’t just imagining him, right? He was alive in there. As I laid in my hospital bed and turned towards the ultrasound monitor, there was no head to toe measurement, no blinking heart, no sign of any life at all. The baby that held such promise in its tiny, webbed fingers had vanished. The nurse glanced down at me, moved her hand from the computer mouse to my wrist, and offered in a weary voice, “I’m so sorry.” A tear slipped down my cheek and seeped into a crease in my neck as she silently wheeled me back to my hospital room.

A doctor with eyes like periwinkle marbles came into my room. His voice was kind: “Well the good news is that you passed everything naturally.” That’s how the medical community talks about natural miscarriage – as passing all of the tissue. This sounds like a win, something to celebrate, like I’ve just passed the test or passed over the finish line. But what seems more fitting is lost. “You’ve lost everything, all of the tissue was lost, someone was irretrievably lost.”

Ben and I arrived home around 2 A.M., heavy with fatigue, and fell into bed. The next morning was a Monday. Ben left for work and I got up and showered, dried my hair, put on makeup: simple tasks that felt brave considering yesterday’s events.

I called my sister and five brothers one by one and summarized in a few seconds the heart breaking result of the last ten weeks. My younger sister burst into tears, wishing she could be with me, telling me she didn’t know what to say. I called my brothers. “I’m really sorry,” one said. “I’m so sorry to hear that,” said another. The conversations were brief—they didn’t know what to say or didn’t want to pry. I was glad I told them. A few weeks later, I got a note in the mail from one of my older brothers. Just three years prior he had endured the unthinkable horror of losing his three-year-old son in a drowning accident. His tiny cursive font read, “There are no words to extinguish the grief and anguish of loss.” His words covered me like a healing salve. I was going to be OK.