Part 13: Crimson Tears

She felt like a product on an assembly line. One by one the clinical assistants in radiology brought the patients into the dressing rooms, spouted off a memorized set of instructions, and handed them unflattering blue smocks to cover themselves. After changing, the woman went out to sit in the secondary waiting room, where she fit right in with the rest of the like-dressed patients. Shortly thereafter, she was escorted to a room to receive her ultrasound.

“I’m so sorry,” the woman apologized to the technologist, embarrassed by something she couldn’t control. It had been about an hour since she left the house for the clinic. The double-layer protection she thought would last a few hours had already lived its course and she was on the next round thanks to her husband who had packed extra pads against her wishes.

She lay on the exam table worried about how much blood she’d find underneath her afterward, while the technician maneuvered the ultrasound wand and diligently reviewed the images on the screen.

“Are you going to tell me what you see when you’re finished?” the woman casually asked.

“No. You’ll have to wait to discuss the findings with your doctor,” the technician succinctly replied.

Goodness. These technologists in radiology are way stricter than those in OB. Guess it won’t be the first time I’ve waited for answers.

The technician finished the scans and gave permission for the woman to leave. She met up with her husband and they walked over to the doctor’s office.

“The HCG results have come back and they have gone up again since your last draw five days ago,” the doctor began. “After reviewing the ultrasound, there seems to be re-growth of tissue in your uterus. We located a mass inside measuring about 3.5 to 4.0 centimeters and it seems to have grown into the uterine wall.”

A mass inside? the woman thought, shocked.

The doctor continued, “I took a look at your pathology results from the D&C and the cells did not have the appearance of choriocarcinoma, which is good. However, they have definitely started to invade into the uterine wall, which is a concern. We don’t want to do another D&C at this time because of the risk of possibly puncturing the uterus, which could cause uncontrollable bleeding and lead to hysterectomy.”

The word “hysterectomy” made the woman shutter.

“We want to preserve your fertility as best we can. The next step will be to get a CT scan to verify the cells have not spread to other parts of your body. We want to keep you overnight in the hospital to monitor your bleeding and make sure that goes down. And then we will also start you on chemotherapy treatments today.”

The woman felt like she was listening to the text book treatments she read on the internet and in online medical journals. The information was very familiar, but it wasn’t supposed to be her story. It was supposed to be some impersonal nice-to-know information that she didn’t have to worry about. But it was her story now, and somehow she would have to deal with it. All the times she had been given less than good news, she had been able to keep her composure, but this time was different. Though she didn’t know where else the crazy cells in her body may have gone, they had finally managed to get to her psyche and through her tears, she released the emotions that had been building inside her all day.

Part 6: Snowstorm

His emotionless eyes said it all. The doctor glided the ultrasound wand over the woman’s belly as he gazed intently at the screen. Though she didn’t know what he saw, she knew what he didn’t see. There was no baby. If there were to be, this would have been the time for it to show up on the monitor and he would have said something right away. He would have smiled. Instead, his face was somber. It screamed amidst the silence: There is no baby.

If there is no baby, then what is it? How could I be feeling all these symptoms and there be no baby? she wondered.

Finally, the doctor spoke up. “I still don’t see a fetus. What I do see is a little more concerning. This ‘snowstorm’ appearance indicates to me something along the lines of what is called a hydatidiform mole or molar pregnancy, but we will need to get a clearer ultrasound taken to be sure.”

“Hide-a-didda-pole what?” she asked.

“Hydatidiform mole.  It is when there is a genetic abnormality starting at conception...”

The woman drowned out the rest of his explanation as her mind wandered off on a tangent. Abnormal. There was that word again. Since the beginning none of this had been normal. She had to wait three married years before getting the opportunity to start trying for pregnancy. She had started bleeding 6 weeks into her pregnancy and it still hadn’t stopped yet. They never saw anything normal on the ultrasound. Her miscarriage did not happen normally. The only normal thing about this whole experience is that everything was abnormal.

“…cancer…”

Did he just say something about cancer? she thought. Apparently certain forms of this disorder could turn into cancer. Great. Even better.

The next ultrasound couldn’t come soon enough. She knew the drill for these vaginal ultrasounds by now. Not pleasant by any means, but if it meant better answers, it was certainly worth it.

The ultrasound confirmed the doctor’s suspicion. “This is definitely a molar pregnancy,” he said. “It happens in about one of every thousand pregnancies.What I don’t know is what kind. There are two possible types: complete and partial. Based on the ultrasounds we’ve seen, I would suspect you’re suffering from a partial, which has fewer risks involved.”

"Just out of curiosity," the woman began, "how often do you see this here?" The medical institution where she was receiving her care was well-known. Perhaps this happens a lot here, she thought.

The doctor replied, "We see this maybe once a quarter."

Wow. I guess not very often.

He continued, "But this condition has been around long enough that we know exactly how to treat it."

He referred them to a surgical gynecologist who would be able to give them more details. They set up an appointment for early that afternoon and made their way over to the next waiting room.

Part 4: Something Normal

“I believe what I’m seeing here is the sac and this would be the fetal pole,” the ultrasound technologist reported, as he zoomed in to show the couple a closer look. “But this does not look normal to me. Considering you are eight weeks along, it should have been much bigger by now.”

The couple then moved to another room to discuss the situation with the doctor. While they waited, a spirit of relief calmed them.

 “Well, at least they finally found something,” the woman said to her husband. “I don’t mind being told I’m abnormal as long as there is something normal in there somewhere!”

The doctor finally arrived. He explained to them that it was indeed a miscarriage and that he believed that the bleeding she was experiencing was caused by a detachment of the placenta form the uterine wall. He discussed with them the options available to deal with the miscarriage. The couple decided to forego intervention methods and let it happen naturally.

“How long do you anticipate until this miscarriage will occur?” the woman asked.

“Based on the amount of blood in your uterus, I would imagine it would happen in the next few days,” the doctor replied. “Be sure to make an appointment after it happens so we can make sure you’re okay.”

“If it doesn’t happen as you say, how long should we wait before seeing you again?” the husband asked.

“If in two weeks you still haven’t miscarried, come back in,” the doctor said.

The couple left, and as they drove back home the woman could not help but relive the car ride from two weeks prior. Another dose of bad news, she thought. This is really happening. This pregnancy did not work out.

She grieved.

Fears about the miscarriage plagued her mind. How bad will it hurt? What if it happens while I’m at work? How do I move past this? She sent up a prayer for strength and courage to make it few the next few days, resting in the peace that followed.

Part 3: Emotional Gymnastics

It was the day of the woman’s second ultrasound. Her hypochondriac tendencies nearly drove her mad the week before, but today was the day where she and her husband would finally be able to get some closure.

“I can say with certainty that this is definitely not an ectopic pregnancy,” the doctor reported after viewing the latest ultrasound scans.

Relief swept over the couple.

The doctor continued, “While your hormone levels did double like normal this past week, based on your ultrasound we believe that they will soon be on the decline, as there is no visible fetus present. You are going through a miscarriage, which should happen at any time. We want you to get another blood test just to be sure these levels are trending downward.”

“So, I should expect to see that the hormone levels have gone down from last time?” she asked.

“Yes,” he confirmed. “Someone will call you with the results once they are in.”

The woman and her husband made their way down to the lab services. The short elevator ride gave her time to reflect on the news. Well, at least we know what’s going on, she thought. This will soon be over and we can try again. The unknowns of miscarriage scared her and the loss of the little life inside grieved her, but she was hopeful that one day there would be new life, redemption to glory over the sorrow.

The phlebotomist rubbed the woman’s arm with alcohol and she turned her head.

“Don’t worry. It’s not you. I just don’t like needles,” the woman said and breathed deeply. In a matter of seconds it was all over and she headed out the door with her husband.

For the remainder of the day, the woman sat at her work desk trying to focus, but all she could think about getting the call with her test results. She waited an hour. She waited two…three…four. Finally, the day was over and she had still not received a call. Impatience getting the best of her, she called the off-hours nurse line to get the answer.

“Looking good!” the nurse said excitedly. “The levels have doubled from last time.”

“Um…that’s interesting,” she replied, puzzled. “I was told they were supposed to be going down since I am having a miscarriage.”

“Oh, dear! I’m so sorry!” exclaimed the nurse, noticeably embarrassed. “I didn’t look at your history first. I’m so sorry. You’re right. It’s been five days since your last draw, not two.”

“That’s okay. I just want to know what that means, since the doctor said they were supposed to be going down.”

“Well, you’ll have to check back with your doctor about that,” the nurse replied, and the two of them hung up.

A call to the doctor’s office the next day began with confirmation of the prior day’s blood test results, but unexpectedly followed with a request to come in again for yet another ultrasound for the following week. The woman wasn’t sure what to make of this, considering the fact the doctor had told her the day before that she would not come in again until after the miscarriage delivered. Sadness. Hope. Despair. Possibility. The emotional gymnastics were starting to wear on her, but she did not want to give up on her baby if her baby wasn’t ready to give up on her.

 Perhaps I am still pregnant, she thought. Maybe they were wrong.

Part 2: Puzzles

“What do you mean I puzzle you?” the woman asked, cold and uncomfortable on the exam table. She was six weeks along and had been bleeding slightly over the last three days. The prior five minutes of poking and prodding amidst silence was bad enough, but “You puzzle me” being the first statement out of the ultrasound technician’s mouth did not offer any reassurance.

The technician responded, “I’m not seeing anything that resembles a fetal sac. This does not look normal,” and she left the room to get a second opinion from a doctor.

Humming from the ultrasound equipment resonated through the room while disbelief resonated in the hearts of the woman and her husband. Anticipation for a more detailed explanation rose within her. The additional five minutes of waiting felt like an eternity.

She turned to her husband, “This cannot be good.”

Finally, the doctor entered the room. Through his British accent, he matter-of-factly explained how the woman was either dealing with an ectopic pregnancy or a normal miscarriage. He wanted to get some blood tests in order to track her hormone levels to determine which one of the two was the culprit. He requested that she return in a week for a follow-up ultrasound.

The woman left the clinic devastated. Anger, disappointment, sadness, anxiety, and fear wrestled with each other to get their fair share of attention. Unable to bridle them all, she sat in the passenger side front seat and wept as her husband drove her back to work.

“Why is this happening? It wasn’t supposed to be this way!” she cried, pleading to God through her tears for some divine explanation.

There was nothing more she could do for the next week but wait and wonder. Either there was an embryo attached somewhere it shouldn’t be, which could threaten the woman’s very life, or the little life that had been there never made it very far and was gearing up for miscarriage.