Wednesday, Thursday, and Friday Were Rough

On Wednesday morning, I lost a pregnancy. I was only 6 weeks pregnant. Not much. I spent the morning observing the first grade ICT class (“integrated co-teaching,” meant to be a mix of general ed kids and those with special education needs), on the suggestion of Ruby’s kindergarten teachers. I saw children do things I would be shocked to see Ruby doing in a year (reading books aloud in a small group without a teacher) and I saw children doing things I have every reason to believe she will be doing–playing word games and receiving fist bumps for everything they got right from a very sweet, very tall male teacher. I’m a bit baffled by Ruby’s current teachers’ skepticism of her ability keep her head above water next year.

I used a miniature toilet in the girl’s bathroom and discovered the bad news. I’d had a lot of cramps overnight so I wasn’t completely surprised. I went home and lay in bed, then called the ob-gyn office where I’d made an appointment for the end of December, but hadn’t yet been seen.

A doctor called back and told me to get a sonogram and then have bloodwork in the morning.  That evening I left Ruby with Andrew and went to the radiology clinic where I’d made an appointment and heard the receptionist call the doctor’s office for the referral for the sonogram. But when I arrived, the receptionist said they didn’t have the referral and thus couldn’t do the sonogram. While she looked for it, her mother called her 3 times and she answered, grumbling that she couldn’t talk because she had patients. She made it clear that she was having a bad time, but she also showed me a reasonable amount of compassion. When I got a doctor on the phone–a new on-call doctor–and explained that her colleague had instructed me to come here, at this time, for a sonogram, because I thought I was having a miscarriage, she told me that since I wasn’t an established patient at their practice she could not legally write a prescription for the sonogram.

I sat down and cried. When the receptionist asked if I was okay, I said I was just annoyed. The radiologist tried to comfort me by saying she’d just seen a woman whose hormone levels were very low but they’d found a heartbeat, two days in a row.

At home Andrew was giving Ruby her bath. I didn’t want to speak at length so I told him that the first doctor must have been an asshole or not paying attention or whatever, that it didn’t really matter because I knew I wasn’t pregnant anymore, and I still had to go to the office in the morning for bloodwork and could have a sonogram then. I curled up with Ruby, told her I loved her about twenty times and went to bed.

At the doctor’s office on Thursday morning, I explained that the radiologist hadn’t gotten the referral. The receptionist told me she had faxed it, twice, and then called the other receptionist, saying, “well I feel bad because I have to face the patient,” and accepting the apology.

I waited with mostly Hasidic women at various stages of pregnancy. There was also a man, a husband, a big fat asshole in a tracksuit with a fanny pack and a clipboard, who made it clear he didn’t mind interrupting the calm of a room full of pregnant women dressed in black waiting to see their doctor by loudly organizing a series of financial transactions and LaGuardia airport pick-ups on his phone.

I saw the doctor I had spoken to first. He asked how I was doing, chastised me when I said I wasn’t sure when last I’d had a pap smear (“see, that’s why the other doctor didn’t want to write you a prescription”), and the only time he said sorry was when I said, in my brief medical history, that my daughter is developmentally disabled. He did the sonogram, told me there wasn’t really anything there, and said I should have bloodwork to check hormone levels and come back next week.

I thought about going Christmas shopping, but instead went home and put my head under the covers. Then I got an email from a magazine editor–someone who had contacted me a year ago asking about my writing, and then gamely read an entire manuscript. I didn’t end up submitting anything for her magazine last year–work and commuting and Ruby and getting married and moving from Washington to New York were keeping me from writing–but while luxuriating in stay-at-home mom mode I’ve decided to keep trying, and I’d written her with an idea for an article.

So as I lay there having a miscarriage, I read, “I do remember you because I took time to read your whole manuscript. Actually, I was surprised I did not hear from you afterwards.”

I never wrote her back. She, a stranger, an editor, read my indulgently intimate project and liked it, and wrote back saying she wanted to know how it all turned out, and I never–I searched back through our correspondence and confirmed it–I never wrote her back. I thought I had. But I hadn’t. I had forgotten.

I wasn’t going to tell my mother about the miscarriage. I’d planned to tell her I was pregnant at Christmas, but I had decided that now–that I’ve moved out of her house, that I have a loving husband–I didn’t need to tell her about this. But the revelation of having stupidly, unwittingly burned bridges at the very same time I was losing a baby pushed me over the edge and after hating myself for another hour I called her.

When I said that I’d known I was pregnant for a week, taking the test a week after missing my period, and talked about how hard it is not to think about getting pregnant now that I’m in that frame of mind, after being so careful about birth control (since Ruby came along, that is), she said that it’s too much information. Not what I told her, though she might have thought that, but the tools available to demystify a woman’s body. She’s right. The fertility calendars a Google search away were simply irresistible to me in the months after my wedding when I still lived in Washington and saw Andrew only every few weeks. Embarrassing, irrelevant, pathetic, and icky–but irresistible. Pregnancy tests are now easy and cheap and so sensitive that they will tell you that you’re pregnant when, perhaps, a reaction between two cells has occurred but your body is still deciding whether or not to host a baby. Surely I’d be better off if I’d never known.

On Friday, I went on Ruby’s class trip to the Museum of Natural History. Ruby was as good as gold, she even drew a bird.

Afterwards I had a message from the doctor telling me I needed to take a Rhogam shot.

Rhogam is a drug given to Rh negative women during pregnancy and after labor or a miscarriage to prevent them from developing antibodies against the Rh factor if they are exposed to the baby’s Rh positive blood. It’s unlikely that I would be exposed to fetal blood from having a miscarriage at 6 weeks, but if I were, and the fetus happened to have Rh positive blood, and I developed antibodies against it, this could cause problems if I conceived another Rh positive child. My body would potentially treat it as a disease and mount an immune response.

When I called back, the doctor’s office was closed for the weekend (at 2 pm…Shabbat?) and the receptionist declined to call the on-call physician because it wasn’t an emergency. I wasn’t yet in a fighting mood, just confused about why I needed Rhogam after such an early miscarriage and whether I was supposed to just wait all weekend before taking it, so I called a nursing school friend who is now a newly minted midwife. Like all nurses, she loves being interrupted on Friday afternoon to deal with someone else’s pressing health concerns.

She told me that taking Rhogam so early is indeed the standard of care, though plenty of professionals don’t believe that’s actually necessary, and that it’s supposed to be taken within 72 hours, so waiting until Monday wouldn’t work. She offered to write the prescription herself, but why didn’t I get the on-call on the phone and find out what they really thought I should do?

In the meantime, I wanted to know Andrew’s blood type because if he is Rh negative too, there’d be no chance the miscarried baby was Rh positive and Rhogam would be a moot point. This is not an option presented at the doctor’s office, in general–they don’t trust that knowing the husband’s blood type means knowing the father’s blood type, and they don’t take that risk with an unborn baby–but on Friday night with the office closed it was up to me to take it or not. I had driven Ruby to therapy because riding the train to and from the Museum of Natural History with 24 kindergarteners had exhausted my subway capacity for that day, and coming back over the Williamsburg Bridge I called Andrew to ask. He didn’t answer the phone, so I tried again, and then, four blocks from home, I got pulled over for the first time in my life.

The cop asked what the emergency was, was I calling 911? and then said hi to Ruby. “And is this your daughter? It’s not safe for her back here…” Not only can you not carry a child or email people back when it’s important, you’re also a bad mother in the most basic of ways.

I apologized to Ruby while we waited for him to write me up, and then we were on our way, until we were around the corner from our house, and I got rear-ended.

Okay, it was a tap and there’s just a bit of paint chipped off of my already damaged bumper. The girl was sweet and gave me the impression of being a nurse before I realized she was wearing a monotone velour suit and not scrubs, and I told her I was having a bad day and I just wanted to go home.

Andrew doesn’t know his blood type. He called his parents to ask if they knew. His father wanted to know why, told him not to be coy, and when Andrew said it had something to do with pregnancy, I yelled at him sharply, “DON’T make your father think I’m pregnant.”

When the doctor called back he said it would be fine to take the Rhogam on Monday, and I said isn’t it time sensitive, isn’t it supposed to be taken within 72 hours? and told him that I’m a nurse and could give myself the shot if he called in a prescription. “Oh, you’re a nurse? You didn’t mention that.”

“I was distracted by the fact that I was having a miscarriage.”

“I know, I’m sorry.” The man was so much nicer to me after I told him that I’m a nurse. He told me to hang in there. He said that the 72 hours came from the original studies of Rhogam which were conducted in a prison, that 72 hours was basically an artifact of the study. I didn’t quite follow this, actually, and told him that if he really thought that I should take the Rhogam–he did–I would rather take it in the time frame recommended for the drug’s efficacy. So he called in a prescription and I drove to a pharmacy, picked up a new plunger while I waited because by the way, our (only) toilet had been clogged since Thursday night, got lost on the way back and made use of my speakerphone to get hands-free directions from Andrew, came home, took my pants off, and shot myself in the thigh with a 1.5 inch, 22 gauge needle.

That was the only good thing about these three days–other than Ruby being so awesome on her trip, other than being reminded to count my blessings, and blessings, and what I can’t help but think of as blessings, despite the fact that I don’t, and just can’t, believe in God. I used my hands to do one small, useful thing that as a nurse I know how to do. My chance of being exposed to fetal blood was so small, and the doctor was so lackadaisical about when the Rhogam would be effective, that I expect what my midwife friend suggested was right: the company that makes this drug must be pretty satisfied with their marketing efforts. I doubt I needed it at all, but at that point, I think I wanted to finish this story by shooting myself in the leg.

I’m fine. I feel better. It’s not really a big deal. I know women who have miscarried at six months, women who have labored to deliver a dead baby. And gone on to have beautiful healthy children. I know we don’t usually talk about this. I just thought that if I skipped it and went straight to talking about making coffee cake, I would feel like I was lying, and I don’t like lying.