Image Credit: “Better than We Ever Did” by Elizabeth Walker
The doctor calls with the news. In the lab: the embryologist partners fifteen retrieved eggs and a thawed vial of sperm. In the petri dish, fourteen embryos divide and multiply. Outside the body, pregnancy begins, high risk. The patient says thank you for calling. Thank you for letting me know.
Sitting beside her patient on the gurney, both professional and intimate, the doctor says they will transfer two grade-A blastocysts to her uterus. The patient, who may or may not be mother-to-be, is told her endometrium is perfect, a lush carpet. On the monitor, she watches the doctor thread the catheter through her cervix; the doctor points out the embryos, small specks of light which represent the air and fluid surrounding them. After the procedure, the patient is instructed to eat something decadent. Brownies with flaxseed. A movie on Netflix. The doctor hands her a prescription for Valium-induced sleep. I need you to rest, she says, as if it’s a personal favor.
In the privacy of her bathroom: Two pink lines. Later, the nurse calls with the news: her beta HCG is 81. At least one embryo has latched on, tight.
The patient calls the clinic, bleeding. The nurse follows her script, cites statistics about spotting in IVF pregnancies, the use of vaginal progesterone. She says to call the clinic if there are signs of miscarriage, to go to the ER if she is soaking more than a pad per hour, if she is in serious pain. The nurse doesn’t know that the patient writes in her notebook the reign of terror begins.
The nurse calls with the results: beta HCG is 367. She says the number, the rise since the last blood test, is insufficient. She uses the term she has been instructed in these situations. She does not say what she knows: miscarriage is probable. She says the doctor will call the patient later to discuss the results. That night, on the phone, the doctor says it could be okay; it could be a twin that is not going to make it. The patient says, so you’re not worried; she thinks she can hear the doctor’s children playing in the background. The patient knows that the doctor has learned not to become invested; still, she wants to believe she is not any ordinary patient, this is no ordinary baby. It is what it is, the doctor finally says, her voice flat. She wants all her patients pregnant in the abstract.
On the screen, the yolk sac comes into focus; the tiniest circle of possibility. The doctor has been holding her breath; exhales softly.
In the ultrasound room, the doctor points out the embryo on top of the yolk sac; she says it looks like a diamond ring. It sparkles, tiny flicker of cardiac activity. There’s another black dot, the twin that’s already stopped growing. The patient holds the gritty image when she walks out of the clinic, past the nurses who congratulate her. Sometimes when patients leave they don’t come back. Sometimes they do.
The day before her appointment terror rises. When the medical technician checks the patient’s blood pressure, it is high. Her weight is low, lower than it has been since high school. She is crazed by the time the doctor comes in to do the ultrasound. The heart is beating but slow. The sac is growing but small. The doctor chooses her words carefully. It is a bit concerning, she admits. Still, she says, within normal limits. This is one of the phrases she cultivated in medical school. In the file: blood test results: beta HCG, E2, P4, antiphospholipid antibodies, blood count. Have your blood tested tomorrow, she says, then, precisely: we might need information later. The patient knows all too well what that means.
The embryo measures 8w5d. The sac measures 7w4d. The doctor does not tell the patient what this means. That is not her job. She does not tell her, please do not google images. If she tells her, she probably will. Statistically there is an 80-90% chance that this pregnancy will end in miscarriage. She does not tell her patient this. She says, carefully, it could go either way; she says she’s had patients like this go on to have healthy pregnancies. She says this could be the patient’s tendency toward blood clots. It could be a problem at any point in the pregnancy. The doctor releases the patient to the care of the obstetrician, refers her to a perinatologist. In the file, the last entry, she scrawls a diagnostic code. There is nothing else she can do.
Later, the doctor leaves a message for the patient on her voice mail, says she’s been thinking about her. She does not know the patient will hold on to the message like a good luck charm for the next thirty weeks.
At the hospital, the maternal-fetal specialist says, look, I do not want you to walk out of this office thinking this pregnancy is doomed. The fact that you are still pregnant is a good thing. We will know more in two weeks. At home, the patient tries listening to the heartbeat with a doppler. She doesn’t know what she’s listening for. It could be her own heart beating. It could be a fetus—it is fetus now—dying.
In her hospital gown, on the examining table at the obstetrician’s office, the patient has already decided she will not come back. She will ask for a recommendation for another doctor, one who understands what her medical chart—three inches thick, bound together with a rubber band—has done to her. A doctor who doesn’t talk about VBAC at the first appointment. How can she possibly have a conversation about natural birth before she makes it out of the first trimester? Eighty percent, eighty percent, eighty percent. She needs a doctor who hears the statistic tremble like a heartbeat.
Normal, the maternal-fetal specialist declares; if I didn’t know your history, I’d assume this is any ordinary pregnancy. After the appointment, the patient goes to lunch with a friend. Tries on maternity clothes. She wants to trust in a happy ending. It feels too good to be true.
At the new obstetrician’s office, diagnostic codes at the top of the chart:
V23.85 Supervision of pregnancy resulting from assisted reproductive technology; V28.81 Supervision of high-risk pregnancy: elderly multigravida, first trimester; 646.3 Habitual aborter currently pregnant; 649.3 Coagulation defects complicating pregnancy, childbirth, or the puerperium
High risk. High risk. High risk. The uterus tightens, doesn’t release; the patient says she’s been having contractions. The doctor asks her to put her feet in the stirrups, inserts a speculum. The cervix is closed tight. It needs to stay that way for at least another 23 weeks. She writes another code. Tells the patient to give her chart to the reception desk.
The ultrasound technician informs the patient that she is having a boy. There is no diagnostic code for the baseball cap she draws on the screen.
The obstetrician refers the patient to a hematologist. In order to see the hematologist, she needs to see her primary care physician for a referral because one specialist cannot refer to another. The patient does not yet have a primary care physician. She cannot find one she wants to see who has an opening. The one she does find cannot tell she is pregnant, although it must be clear from her chart. She prescribes blood tests that are inaccurate when performed on pregnant women. The hematologist, when she finally schedules the appointment, takes another eight tubes of blood. The old acronyms swirl up. APA, ACA, Protein C, clotting times, platelet counts. She says the old diagnosis was incorrect, but, yes, we will monitor this cautiously.
The nurse takes her blood pressure, puts the doppler against her belly to record fetal heart rate. The doctor tries to be kind, says, you can always come in any time you are concerned. She writes a note in the patient’s chart; the patient does not know what it says.
After her appointment, the patient writes in her diary: “Pregnancy after miscarriage was hard. Pregnancy after multiple miscarriages and a train-wreck of a first trimester? That, my friends, really requires valium or large quantities of vodka, both of which are contraindicated in pregnancy.”
At the beginning of the third trimester, the baby is measured. He has fallen off the growth curve. Once he is down to the 18thpercentile, the doctors decide to give the mother steroids, in case early delivery is warranted. She goes to the hospital pharmacy and picks up the vial of medicine, which she brings to her physician’s office for injection. Although she has been giving herself injections since prior to conception, this shot they do not allow her to do herself.
The patient reclines in the chair, the monitors like hockey pucks strapped to her abdomen, one to measure fetal heart rate, one to monitor uterine contractions. When they push up her shirt, they see her belly is bruised. It looks like she’s been beaten. Anticoagulants, she says. It should be in her chart. At first, it’s one shot every twenty-four hours and then when she switches medication, every twelve. Sometimes after a bad injection she doesn’t stop bleeding; it pools under the skin and stains her clothes. She collects the needles in sharps containers; she’s not sure what to do with them. The nurse rips the printout from the machine, places it in her chart.
The patient reclines in the chair, the monitors like hockey pucks strapped to her abdomen, one to measure fetal heart rate, one to monitor uterine contractions. The nurse clucks at the bruises, says, I bet you’re on heparin. The nurses give her juice. It riles the baby up. The nurse rips the printout from the machine, places it in her chart.
The patient reclines in the chair, the monitors like hockey pucks strapped to her abdomen, one to measure fetal heart rate, one to monitor uterine contractions. She is a regular, comes Mondays and Thursdays each week; on Sundays the panic spikes. Gestating, the doctor said, will be a full-time job; this is what it means to be high-risk. She brings a book to read during her appointments. She waits while the doctor reviews the printouts; if the baby’s heart does not accelerate adequately, she sits longer. Eventually they might decide to send her down the hall, to the ultrasound room. She has learned that if a baby looks okay on Thursday, it’s not likely that anything will go wrong until the next monitoring session. She has gathered that monitoring any more than this does not provide that much more information.
The patient reclines in the chair, the monitors like hockey pucks strapped to her abdomen, one to measure fetal heart rate, one to monitor uterine contractions. She brings a book to read, though concentrating on words becomes impossible.
No one tells her, but she knows from the ultrasound measurements that the baby hasn’t grown in two weeks. She knows what this means. Tomorrow, the doctor says, or Saturday. The patient buys herself another day. Buys a nursing bra, cleans the fridge.
In the hospital, the patient is informed that her caesarean will be delayed as there is another patient who needs to be delivered, who has been in labor a long time. The patient waits, patiently, and then not so much, with an IV in her arm pumping her with liquids, a blood pressure cuff, a fetal monitor. Her friends sit with her, make bad jokes. One flirts with the anesthesiologist. The patient cries off and on. At some point, she is wheeled to the operating room. At some point, they insert a needle in her spine, dose her up. Her whole lower half is just gone. She is panicked, blood pressure rising, she gathers from the doctor mumbling. A doctor who isn’t the usual doctor will cut her open, deliver the baby. This doctor is kind; will someone, she says, with an uptick of urgency, please get her friend. They put a sheet between her face and her body, where they make the cut, pull the baby out, as, they tell her, he pees, angry, into the incision. He’s okay, her friend says, he’s okay.
They are two bodies now. They have two doctors, two medical charts. The baby goes to the nursery, to be poked and prodded, to be warmed. He has his own numbers now: P05.9 Newborn affected by slow intrauterine growth. Cut out of her, he’s alive, he’s alive, he’s alive. And so, it seems, is she. How all these weeks of worry come down to this.
Much later, when the boy is six, at kindergarten, writing his letters, the mother will put words to everything a medical file can’t say:
It’s easier to write this in third person, easier to detach myself from the woman I was then, patient, six diagnoses that meant high risk at the top of my chart. The pregnancy was not mine, but it inhabited my body. My doctors controlled it. In the doctor’s office I conceived, in the doctor’s office the embryo grew, was monitored, was cut from my body on the operating table. I was given a baby to take home and left unattended, unwatched for the first time in a year. At my six-week visit, the nurse asked why I was crying. I couldn’t explain that I was still sure I’d never be allowed to keep him. H. is now six, at kindergarten, sounding out words in a sixteen-page book. My body is mine again, a bit softer, with scar tissue from blood draws and birth. It all feels small and faraway now. But I remember those days pinned to my bed, days I swung from hope that it HAD to be okay, trust in my doctor to take every precaution, and certainty that it absolutely would not. At night I read H. a book about how babies are made, show him the picture where he looks like a pearl earring, beautiful and impossible cells that turn magically into a boy.
Robin Silbergleid is the author of two books that grapple with single motherhood and infertility, The Baby Book (CavanKerry Press) and Texas Girl (Demeter Press), as well as co-editor of Reading and Writing and Writing Experimental Texts: Critical Innovations (Palgrave). She teaches and directs the Creative Writing Program at Michigan State University. She also collaborates with the infertility art, oral history, and portraiture project and traveling art exhibit The ART of Infertility.