Tuesday 18 July 2017

19 April 2017: Lemonade, Beer, and shandies.

We had an appointment with my consultant for a follow up after the miscarriage.

It was also to get the results of the post mortem. We arrived and he explained that not all the results were back yet. So we had yet more waiting. He went over the information he had, explained to us that our baby had a missing eye, a malformed nose, and a cleft palate. He stated that he was waiting for the chromosome test results to come back. He offered a follow up appointment, but also suggested that he might be able to speak to me on the phone, although if the results were a certain way he would need us both in again anyway. So I requested another appointment, as I knew that if I didn't have one set up, and had a phone consultation asking us to come in... well, I think the bag would have split, and the nerves would just be in a puddle on the floor. I kept calling, asking if we could have an earlier appointment, as we were given 19 April 2017, and I just wanted all the information, so we could get on with it. One day, I was speaking to Dr. Gordon's secretary and she informed me that the results were in, and suggested that Dr. Gordon could call me. So call he did. He explained that the baby had too much of chromosome 13, and they needed to check if it was a random mutation when the baby was formed, or if it was something that was part of Lee or I. We were in the next day for some blood tests.

The test results were ready on 19 April 17.

Lee thought that seeing something drawn on the piece of paper on the front of my notes was not a good sign when we sat down. He was right.

Science Lesson

Most people have 46 chromosomes. If you imagine all the chromosomes as different drinks: water; milk; lemonade; beer... Lets say that chromosome 13 is lemonade, and chromosome 4 is beer, and most people have two lemonades, and two beers as part of their chromosomes. Sometimes, a balanced translocation can happen, where the lemonade and beer mix together as they are being poured. So what happens is that a person has one lemonade, one beer, and two shandies. In terms of that person, that's completely fine (usually) and they grow and develop normally. It's only when they try to procreate that things go wrong. When the body makes eggs and sperm, it takes only half of the chromosomes needed to make a person, because the other half comes from the other person. What that means is that in someone with a balanced translocation, instead of always producing eggs or sperm with one beer and one lemonade, they create either:

A. A beer and a lemonade
B. Two shandies
C. A beer and a shandy
D. A lemonade and a shandy

Now, given we need two beers, and two lemonades.

If we have option A or B, we should create a "normal" embryo, which creates a "normal" foetus, which grows and develops into a baby that is able to survive, grow, and develop in the way that the majority of the population do.
If we have option C, we have too much beer, and not enough lemonade.
If we have option D, we have too much lemonade, and not enough beer.

End of lesson.

So, on 19 April 17, we were told that two out of four options would be viable, and two would not. Always. That's 50% chance of a healthy pregnancy, 50% chance of either a miscarriage, or a disabled child. The severity of the disability, we don't know. We don't know if it would get that far, or if it would die earlier than our first.

Dr. Gordon was not able to give us a lot of information, he's not a genetics specialist, he's an obstetrician/gynaecologist. He confirmed that we would like to be referred to the geneticist to discuss the options, the chances - because apparently it's not quite as simple as 50/50, given the chances that the defective options might not survive long enough to actually successfully make it to the table. They might fall off the drinks tray early; it just so happened that this pregnancy didn't fall off the drinks tray.

That news, when written down, or explained, doesn't seem so bad really; 50% chance? That's quite good if you're talking about winning the lotto, but we're not. We're talking about our hopes and dreams for the future. We're talking about the changes that have to be made in the way we go about realising those hopes and dreams. We were told to hold off trying until we had seen the geneticist. We were told that we may be offered IVF, with pre-implantation genetic diagnosis. We had to come to terms with the fact that one of us, if we had chosen anyone else, may not have had to deal with this heartache. However both of us are in this together, and both of us know that to even consider being with anyone else is not what we signed up for when we got married. Since that news arrived it's been a paradigm shift for us, in so many ways.

22 March 2017

First written as a note to myself, and sent on to my husband, on 22 March 2017. I want to be ready to try again. Physically ready. I don't actually know if I'm ready otherwise. I am currently focusing on the waiting to be ready, to be told we can try again. I know it will be crushing if we are told there is an issue. A barrier. A stumbling block. Issues can be worked through. Barriers can be taken down or broken. I can get back up.

The difficult part lies in the number of people telling me I need to wait until I am mentally ready. They make me question if I am. I thought I was, but do I think I am? The past and present tense are in contradictions, and what of the future? I am not having sex with my husband. I miss the closeness of that. I am barely even kissing my husband. First to not catch his cold when my immune system was so weak, and then to stop passing the oral thrush that developed with my antibiotics back and forth. I would like to be able to be close again, to not have those barriers, to figure out if what is beyond them is somewhere I am ready to go. Barriers can be taken down.

I can get back up. I can move forward. I can remember the child that we did not meet.

I am ready to find out. I am ready to know if I am physically ready. I am ready for someone to show us what has been making up those barriers. A scientist to look at the chromosomes and tell us what they were looking for, a doctor to explain to us the future possibilities. I am ready to be looking at the road ahead, ready to take my foot off the brake. Am I ready to be doing that without full control of the steering wheel?

I know one thing for certain. I have always been impatient, and this waiting to find out is hard. The waiting to try. The waiting for each significant date to pass. I want to be pregnant again. I want to be looking forward to the future I envisioned for us. I want to be pregnant before my due date passes. I don't want to replace my child. I worry that I will be trying to if we try again too soon; if I am pregnant before my due date. However, I don't think that worry is founded. I will always love my first child. I wanted a future for that child. We have a future in another direction. The steering wheel cannot go full circle to take us back. We can only move forwards.

I hope the issue is that our child was a one off, something with a low chance of repeating. And yet... I do not want to say that, as it seems as though I am admitting that our child would not have been loved with their disabilities. Our child was loved from the moment of conception.

I hope that the barrier is simply a haze of smoke, not something that requires heavy machinery to conquer.

I hope that the only reason I have not been able to get back up since stumbling is because someone is holding the information just beyond my grasp. The information that helps me jump over that block. As whatever that information is, I will be taking my foot off the brake, and letting go of the steering wheel.

8 February 2017

I did not lose a baby; I know exactly what happened to our baby. I did not "mis-carry" my baby, although I miscarried. I lost a month.

Through the haze of the month we learnt a number of things, the first, and most shocking, was the devastating news that our baby's heart had stopped beating.

What I didn't write in that Facebook post about the people of the NHS was that my husband was not with me when I first heard the news, he was en route, and had a call from me asking how close he was, in between Kirsty telling me she needed a second opinion and that second opinion confirming what was true. I didn't write that Kirsty started to explain things to me but I asked her not to say anything until he arrived. I wouldn't have been able to explain it to her at the time, but I needed not to hear anything that I might need to know, I was afraid of forgetting it. It was not that I didn't want to hear it, it was that I didn't want to forget something important, I needed those back up ears. I actually had to explain to her that I meant for her not to tell me anything about what happens next until he turned up, as she didn't really know how to deal with telling me the news either; I don't think she had had much experience of that side of things before.

We made our way home, parking one of the cars in a residential area near the hospital, where the parking was safe and free. So neither of us would have to drive far on our own. We had planned to go shopping that evening, so we shuffled around the shop, and probably took over 10 minutes just to buy a single pizza (pre-made.) We got home and left it in the oven. Neither of us much felt like eating anyway, so we ate around the black bits.

My mum arrived the following day, and after we picked her up from the train station, we picked up my car for her to drive it home. She was there for the consultant's appointment at the hospital on the Friday, and we went for tea and cakes afterwards. There was a lot of tea and cake that month, to get out of the house.

On the Saturday, we were both starting to come to terms with the news, and still shuffling around like zombies. We chose to go out shopping, not far, but far enough. We looked at kitchens, we looked at things to fill our kitchens, then we went for tea and sandwiches, just to change it up a bit. I don't think we spent more than half an hour in any shop, but we were out and moving. While I can't speak for my husband or my mum, it was really difficult to face "The Public" for me. I knew I was pale and shocked looking (I didn't have the energy to figure out how change my face from shocked to anything else) and I was scared of how strangers would react to that. I have had strangers, in the past, tell me to "Cheer up, it might never happen!" I was scared of if that or something similar was said to me, what my response was likely to be. I formulated responses in my head, just in case, but none of them fit. I had the angry response, I had the sad response, and I had the ignore response; thankfully, I didn't have to use any of them. You see, what could I have said to anyone who was making any comment on my mood? "I have had a miscarriage"? But it hadn't happened yet. "I am having a miscarriage"? I was not currently having one. "I am about to have a miscarriage"? That would have raised all sorts of questions, that I didn't have the energy to respond to. There is no word in the English language for carrying your dead child and waiting for the inevitable. I'm glad that I did not come into contact with the kind of people who feel it's appropriate to comment on other people in that way, I know they are out there, everywhere, but thankfully, I did have that reprieve. Or else they saw me and my appearance sucked all the energy from them to do anything! Emotionally the whole experience was exhausting, before I even got to the physical part.

The medical management of a miscarriage on the NHS in Scotland involves a two stage process, I had to go to Perth Royal Infirmary on the Monday to be given a single pill, that would prepare my body for what was to come. Then, because I was further along than the majority of cases, I had to go to Ninewells Hospital in Dundee for the second part on the Wednesday. I think it was to do with staff knowledge, or resources, I don't know. We arrived on the Monday morning to be told that Dr. Gordon had had to go into surgery, and had not signed off on my medication, so we went to the hospital cafe, for tea and cake. When he was out of surgery, I was given the pill, and it was such a final moment. I was acknowledging, for the first time through my actions, and making a definite choice, to speed the process up. I think until that point I had not truly admitted to myself that it was real, but by taking that pill, true or not, I was starting the process to remove the baby. I dropped it. I panicked then, I didn't want to lose it, to have to wait for another pill to be brought out, I didn't drop it deliberately, but neither did I want to take it. It was explained to me that after taking it, I might "spontaneously mis-carry" a term I didn't much like at the time. The idea of it all happening when I was at home, or out and about, I was terrified.

The Tuesday morning was the first morning I changed from taking the during pregnancy multi-vitamins to the pre-pregnancy multi-vitamins. I had known almost a week. We stayed at home on Tuesday. I started getting cramps on Tuesday night. We didn't sleep much that night. We didn't sleep much any night.

We got to Ninewells, we didn't know where to go, we arrived to the maternity unit, but there's no way in that way. I'm grateful for hospitals being secure places, but I just wanted to get through to get it over with. I was in a very contradictory place in my mind. I wanted to hold on to my baby for as long as possible, and I wanted it out as soon as possible. We met a few people, one who sent us in the wrong direction, and another who brought us to the right place. We were taken to a waiting room, in the gynaecology assessment unit, and shortly afterwards brought through to a private room, where I was given round one of what could have been 6 doses in 24 hours of the medication to start the process. I remember Emma explaining this to me, and explaining that I would be given another dose every 4 hours until something happened. I remember lying on my side as she was inserting the pills, and saying over and over "I don't want this. I don't want this." Although really, I couldn't have faced the other option, of just waiting. After that we were left alone, I was told to ask for more blankets if I was cold.

When a nurse, Kate, wanted to take some blood and blood pressure a short while after the meds were administered, she asked my husband and my mum to step outside to give her a bit more space. That was fine with all of us, but when she stepped out again to get some equipment, she was gone for longer than I anticipated. I text my husband, to ask him if he could ask to return, but when he wasn't coming back fast enough, my fear got the better of me and I started to cry. Another nurse, Lorna, heard me and came in to find out what had happened. She hugged me, she calmed me down, she didn't leave me until Kate came back. I told her I didn't want to be left alone, so she didn't. I'm really glad she didn't, even if it wasn't really her that I wanted there. The morning passed slowly, and I got colder and colder, and asked for more and more blankets. One of the health assistants found a heater, and brought that into my room. Then Kate came in, took my temperature, told me it was far too high, which is why I was cold, and took off all my blankets, took away the heater, and turned on the fan. I understood why, but it was awful.

At some stage I started to have severe cramps, and was really struggling with them; Lorna suggested I take 4 long breaths of the gas and air, so I did. Or, I tried. After number three I started to retch, and I could barely start number four, it was really making me feel sick. So they decided to give me some anti-sickness medication. The fastest acting stuff is injected in your bum, seemingly into one of my nerves that made me jerk away. They had to stop trying for safety, I'm not sure if it was theirs, mine, or both. So I got some oral medication instead. I'm not sure I really needed it, because the only reason I was feeling sick was the gas and air, and if I wasn't taking that, I would have been fine, but in pain.

It was coming close to the four hour point, I wasn't looking forward to the four hour point. The time that they would again have to insert more medication to speed up the miscarriage.

I was still in pain, and Lorna suggested that it was time to push. The thing is, with a miscarriage, because they want to take it all away as quickly as possible, they asked me to use one of those disposable bed-pans on the toilet. So we went into the tiny toilet cubicle, me, Lee, and Lorna. I tried, I really did try to push, but I didn't really think I was ready, I wanted to be, although I knew I never would be. I went back to bed.

It was getting closer to that four hour point, and my waters broke. I hadn't expected that. I felt things moving, and I sat up, and felt the liquid trickling out. I went back to the toilet, just with Lee this time, and made it just in time. We both saw it, our baby. Just for a split second, then he had me look at him. The bell to call staff in was pulled, and Lorna came back, she pulled the bell again, and they helped me back to the bed, as it wasn't coming out cleanly. Dr. Alex had to come in, and help pull out the placenta as I pushed.

When I was pregnant, and excited about things; when my baby's heart was still beating, I had been looking up what was happening every week. By week 12, the placenta is full size, it grows first, then supports the baby's growth. I had a full size placenta to deliver, but it had broken up.

After everything was all cleaned up, the nurses were monitoring my temperature, and told me I had an infection. They had to start me on broad spectrum antibiotics, and keep me overnight. I think a part of me was glad that I wasn't going home. I wasn't ready for it, that would have been another door closing. Monday I closed a door taking that first pill. Wednesday I closed a door going in. I was glad for that tie to my baby that little bit longer. That was my first ever hospital stay, my first overnight admission.

After I had been given some lunch, and was sitting up again, Dr. Roselyn Mudenha came in and spoke to us about what to do with the remains. She talked us through the options, and although her buzzer was going off, she took her time to make sure that we understood, and I didn't feel like she rushed us, or rushed away. There were three options for the post-mortem, and we chose to give consent for the one that would provide us with the most answers. There were more options for what to do with the remains afterwards, and we chose to allow the hospital to deal with the remains, but to keep whatever they needed for future research. I think we thought that if there was anything helpful to be gained, we wanted it done. I'm really glad we were given those options, and I'm glad we chose the way we did.

The sudoku book that was bought on the Wednesday, the one that no one could complete a single puzzle, I finished almost two months later.

The bleeding started on 8 February 2017, stopped on 13 February 2017, re-started on 15 February 2017, changed to a very small amount on 17 February 2017, but didn't completely stop until 21 February 2017. By this stage I had been discharged from hospital with a massive amount of oral antibiotics, which killed whatever infection I had, but also gave me the side effect of giving me thrush in what seemed to be every place a person can get thrush. Due to accidentally being prescribed a paediatric dose of oral medication, that lasted until at least 20 March 2017. I think I also let that infection get particularly bad because I didn't really notice it starting, I was in pain, both emotionally and physically, and wasn't really paying attention to my body and to what form that pain was taking.

I went back to work on 7 March 2017. I lost a month. I did not lose our baby.

10 February 2017

First posted on Facebook on 10 February 2017.

1 February 2017
Her name was Chris, she was halfway through a 12 hour shift. She asked for medical notes, and said that she tells all her pregnant ladies to carry them everywhere from the start; saying that you might just slip and fall in Markies! She took blood pressure, pulse, and the obligatory urine sample. She laughed when she heard the response that the husband should know better than to speed from Dundee to Perth.
Her name was Kirsty, she wore a black dress and a reassuring smile. She asked a few questions, explained that a little brown blood is often nothing to worry about, and advised that a precautionary ultrasound would give a closer look at babba. "There's the head!" Then she went quiet.
She moved transverse with the wand, then back.
She turned the sound on, and quickly off.
The image on the screen showed a pulsing movement in the bottom corner, but nothing in the centre.
"I'm going to have to get someone else in to look at this ultrasound, before..." she trailed off.
"Before?"
She paused. "I'm so sorry, I can't quite see a heartbeat, I have to get someone else in to have a look." She waited a while, observing the world imploding.
Her name was Morna, she observed that the machine was the same as her own. She made the same observation as Kirsty, and offered condolences, while Kirsty reached out to offer a reassuring touch to the leg. The baby measured 13 weeks and 3 days, although it would rightly have been 14 and 4.

3 February 2017
His name was Adam, but of course he was referred to as Dr. Gordon by all who spoke of him. He explained what happens next, he acknowledged the support of the grandmother, and the father, although he noted that he would be suffering too. He asked if it would be ok to do another ultrasound. He said that often, he can observe things on an ultrasound that would provide some insight into the reasons behind it. Evidence that is lost "afterwards". The baby measured 12 weeks and 6 days, although he explained that 2 days had passed since the world imploded, and the baby may not be lying as straight as it once was.

6 February 2017
Her name was not shared, but it was printed on the faded label sewn into her tunic. She explained that Dr. Gordon had to go into surgery, and he was the only one who could sign for the medication. The first pill to prepare the womb for what was to come. When the pill was given, about an hour later, she left the room and said to take as long as was needed.

8 February 2017
Her name was Emma, she was calm and clear in her manner. She asked what had been explained in Perth, then clarified that it would be 4 pills, while apologising that the doctors had not signed off on the painkillers. When she returned, the doctors had finished their rounds, so she came back with the full complement of drugs.
Her name was Kate, her hair was the same faded pink as the dressmaker, from last year's wedding. Through the course of the day she offered encouragement in every form, and was there to witness the signing of the post mortem authorisation.
Her name was Lorna, she held a hand, and held things in place during one of the more un-dignified parts of the day. At 4.02pm, she entered the room to say goodbye, as her shift was over, and remind that support was always available.
His name was Alex, he had a faint Canadian accent, and blue shoes. He completed all his medical training in the UK, and said he specialised in Obs & Gynae after a rewarding placement with supportive people.
Her name was Shona, her grey tunic did not have her name, but the name of the university. She was in her third year, and softly spoken, with a nice smile.
Her name was Dr. Roselyn Mudenha, her buzzer went off as she was going through the consent forms for Post Mortem. She took her time to explain what the options were, and explained how any samples kept for training and research could help.
Her name was Margaret, she was just finishing her shift in ward 36, but said she would be back in the morning.
Her name was Cheryl, she had a perfect little Sassoon bob that somehow showed off her smile. She was there for the night shift, and said that they never warn patients that they would be woken up at 2am for obs, she was there to answer the bell in the middle of the night to the toilet, and offer that reassuring smile to send me off to bed again.

10 February 2017
My name is Emma, and these are the names of some of the people who supported my husband and I through our worst time. They work for the NHS, and they deserve acknowledgement for the work that they do, and support, for the work that they do. #LoveTheNHS

1 February 2017

My husband I married on 29 July 2016, we didn't start trying for children straight away. The main reason for this was because although I was in a stable job and would have been eligible for maternity leave, we had relocated in April 2016, and I had an hour and a half commute which we wanted to shorten before I added the tiring effects of pregnancy to the mix.

I looked for jobs when we first moved, but then planning for the wedding took over, and it was put off. I started job-hunting again in August, and on 30 September 2016, I was offered a job with a 25 minute commute! I handed in my notice, took a week's holiday before starting, and re-decorated our bedroom. In the run up to this, I had started to feel "dis-connected" so the re-decoration was to help me settle, it didn't feel like home; although I think in part that was in relation to the massive commute. That week, beginning 31 October 2016, was during my fertile period. We decided to hit the ground running, thinking that we would never strike the bullseye first time.

My husband went to visit his sister the last weekend in November, I hadn't been able to make it because before it was planned I had already agreed that I would be available to teach at the circus school. It was maybe the Friday that I started to think that I might be pregnant, but I wanted to wait, for the ever so romantic peeing on a stick in front of my husband. I'd had signs, like needing to take naps on the drive home from work, the 25 minute drive; and wanting lots of milk. Sunday rolled around, he got home, and I told him that I all but knew I was pregnant. The pregnancy test we had said that it would take 1-3 minutes to show a positive result, so about 20 seconds after I peed on it, I said to the door "I'm pregnant". I guess the pregnancy hormone was strong in me!

We got excited, we told family. We had a scan (17 January 2017). We saw the heart beating, saw our little wriggler, got the pictures. Told some friends. I travelled home for a family event on the last weekend in January, without my husband. In the airport the metal detectors weren't working, so they were asking everyone to go through the X Ray machines instead. I got to the front of the line, and realised this. I panicked. I said "I don't want to go in there, I'm pregnant!" It was the first time I had told a stranger who wasn't a medical professional. I was allowed to go past and stood to be searched. The lady who stood in front of me asked me how many weeks. It was "14 weeks yesterday" said with a big smile.

I was starting to relax.

The following Wednesday (1 February 2017) I was in work, I had a little bit of spotting, but not a lot. I wasn't too worried, but I was worried. I text my husband, and although he works shifts, he was at work then too. We discussed it, and in the end I decided to contact the midwives and leave work early. I left at 15:30. When I first booked in my midwife had told me that spotting was normal, but to always get it checked out.

The hospital staff were brilliant, I was taken through, and Chris, one of the midwives, chatted to me, took the various measurements she needed to, and the pee. (There's a lot of pee while you're pregnant!) Then she brought me through for a scan, and found a doctor to perform the scan. Kirsty was lovely, she acknowledged that it was a difficult time, having seen the scan, but not yet feeling the movement. She, like Chris, reassured me that the amount of brown spotting I was talking about was unlikely to be of any concern. She squeezed the jelly out, she lifted the wand, she delivered what was, up until that point, the worst news of my life. There was no heartbeat.