You can have the rug pulled out from underneath you, or learn to dance on a moving carpet.
Anonymous
After what felt like an eternity (which I later learned was more like a nanosecond) of trying to conceive, I finally had exciting news, and no one to share it with, apart from my acupuncturist, as Richard wasn’t due home until the end of the week. For days, I sat alone with my exciting secret. I couldn’t tell anyone before I told my husband, and I didn’t want to tell him over the phone.
Richard finally returned home late Friday evening. I was exhausted, as I was every day then, but I waited up for him, perched on the kitchen stool in our front window, watching for his car from the airport to arrive.
When the black Town Car pulled up, I ran to the door and greeted him with a huge hug. We soon settled down at the kitchen barstools, he with a Scotch in hand, me with an herbal tea.
“I have something to tell you,” I said, suppressing a smile.
“I have something to discuss with you too,” he replied. “You first.”
“I’m pregnant. We’re going to have a baby.”
Silence. Confusion.
“The Clomid. The acupuncture. The herbal brews. I don’t know what it was, but something worked.”
“Wow. This is amazing!”
“Due February twelfth,” I continued. “Now, what did you want to tell me?”
“They asked me to move to London.”
“Whaaaaat? Who? When? Why?”
Richard explained that he had been given an opportunity to go to London, but it was only for six months, maybe a bit more. His firm wanted him to move soon, as early as late June or very early July. As exciting and professionally beneficial as the move would be, however, he felt he’d have to pass it up. He thought it would be too disruptive to our lives and it didn’t make sense, especially now given the pregnancy.
To his surprise, I disagreed. “Let’s do it,” I told him. “Why not? It will be a great adventure. It’s a fantastic opportunity for you. We’ll love it. We can travel. The baby will be born there. We’ll just have to stay a little longer than six months and your firm will have to deal with it. We’ll come back after the baby is born.”
We discussed the situation late into the night, and over the next days and nights, getting more excited with each iteration. We chatted about it obsessively until the day arrived when it was time for us to go together to see my fertility specialist for a checkup and the all-important six-week scan that hopefully would yield us our first glimpse of our fetus’s heartbeat. We still had not told anyone about the pregnancy, and had been counseled to be cautious in our optimism until we saw a heartbeat, at which point the odds of a successful, healthy pregnancy increase dramatically. We waited for our turn in the cheerful, yellow office and then went in for the obligatory vitals, ubiquitous blue robe, and, finally, the scan, with Richard by my side. Unlike the first time I viewed a scan, I knew exactly what I was looking at when I saw the dark peanut in the pale gray circle-ish shape, throbbing. THROBBING. That was the heartbeat! The doctor showed us that little flashing plus sign on the screen, and the excitement kicked in. We were really having a baby. On (or about) February 12, 2002. That’s what the computer said.
We made the final decision to move to London, and, all of a sudden, we had a lot to do. It was early June and we were expected to go by early July. We told our families our double news. We were having a baby (much excitement!) and moving to London for a while (mixed reception).
Following my departure from the California tech firm, I had recently taken a new position at a law firm and had started one week before finding out that I was pregnant and just eleven days before learning that my husband’s company wanted him to move to London. Great timing. After only twelve days working at the new firm, I had to go to the head of the corporate department, explain the situation, and ask to be transferred to the London office. It wasn’t a complete disaster, but it didn’t go as well as I had hoped. He didn’t think it was likely in the time frame I was talking about. “Maybe in six months?” he suggested.
Emboldened by the thought of the little throbbing peanut inside me, I told him that wouldn’t work for me. Richard and I needed to be on the same continent. I spoke to a few headhunters. These were pre-9/11 days; the economy was booming, and it did not seem like it was going to be too hard to get a job in London. We decided to forge ahead with our plans, with or without my firm’s cooperation. Two days later, the head of corporate called to say I could go to London with Richard in July. The stars were finally aligning for us.
The pregnancy seemed to be progressing swimmingly. I was extremely tired but had almost no morning sickness, and Dr. Sacks, seeing no further need for his specialized services, had passed me along to a local ob-gyn practice to monitor my pregnancy until the move. I had my first appointment at the new practice, and the doctor there took blood tests and did another ultrasound scan. All looked great. We saw the heartbeat, still looking strong, and the fetus was growing. This ultrasound machine showed an estimated due date of February 16, 2002. I asked about it, as I expected it to be February 12, 2002. Not to worry, the technician said. Machines can calibrate differently. Everything was fine.
The practice saw me again just before we traveled to England. The doctor wanted to do one more scan before we left, and to review the results of the blood tests. To my surprise, the tests revealed what was described as a small problem. I had an elevated marker for toxoplasmosis.1 I had no idea what toxoplasmosis was, but my heart started beating rapidly. How could I be learning of a problem the day before the move? The doctor calmly explained that it might be nothing at all, that it was often detected in women with cats in the household (we had three), that it came from kitty litter, and that the markers might be present in my blood from an earlier infection. I was still concerned. The doctor drew more blood to send to a specialized lab in California and promised to call with the results of the blood analysis, which she warned might take weeks. She advised me to find an obstetrician in London right away and to both inform the doctor of the toxoplasmosis risk and get a scan as soon as possible. In parting, she told me not to think at all about the toxoplasmosis. It was probably nothing.
Our good friends Steve and Shelley host an annual Fourth of July pool party that we were determined not to miss. We were planning to go straight from the party to the airport, and so they kindly turned it into a July 4 / bon voyage party. We had a spectacular time with family and many of our closest friends, and felt on top of the world. We were finally starting a family, as well as embarking on a new adventure. Although we were not yet at the end of the first trimester, when most people consider it “safe” to reveal the big news, given our multiple scans, heartbeat sightings, and assurances that all looked well, we shared our exciting news with everyone at the party. On the last flight of the night on July 4, we were bound for England. We saw fireworks from the plane as we began our overseas adventure.
Unfortunately, it wasn’t exactly the rosy start I had envisioned to our life in London. It was a difficult flight, followed by a bumpy black cab ride to our new home, a super-expensive, super-tiny apartment on Weymouth Street in Marylebone. I arrived nauseous, exhausted, and excessively hormonal. Richard’s company had found the apartment and was covering the rent for the six-month stint. Given the exorbitant cost, I had been excitedly expecting a correspondingly lavish apartment. Now don’t get me wrong here. I grew up in a lovely, modest, middle-class home in Buffalo, New York, and my parents grew up in the Bronx. During graduate and law school, I had lived in housing so substandard in NYC that my brother, Ken, called the city’s office for poison control to complain about the rats. But given the astronomical rent, I’d had visions of those lovely Merchant Ivory period pieces. Instead, we arrived at a tiny, modern, characterless box. I burst into tears. Richard teases me to this day.
I had been told to call the head of my law firm’s London office the morning I arrived, but, tired and nauseous, I crawled into bed. I lay there. Until my guilt got the better of me. Before I went to sleep for the rest of the day, I knew I should call the head of the office. His secretary put me on hold. When he came on the line, he said, “Welcome, hope the journey was good, can you come down to the office now?” I couldn’t answer. “Do you know the way? Sorry to bring you in today, but I am off on vacation tomorrow so it would be best if you could come in now.” Damn. My first morning off a red-eye? The doctors had told me to get lots of rest.
Dejected, I pulled myself out of bed, somehow got myself into a suit, and headed out to the Great Portland Street Tube station, walking slowly in the drizzle past The Portland Hospital for Women and Children, not knowing at the time that it was perhaps the most famous maternity hospital in the United Kingdom, if not the world, and that I would be spending a fair amount of time there in my near future.
After completing the necessary work-related introductions and tasks, I was shown to my new office and promptly began my first project—getting myself an ob-gyn and an appointment. Armed with the name of a doctor recommended by my close college friend Kathy, who is an ob-gyn in Boston, I placed my first phone call, hoping for an appointment that week. No, unfortunately, Ms. Maggie,I the doctor I was referred to, was away on a ten-week leave and wasn’t taking any new patients. Her receptionist referred me to a colleague, coincidentally also named Ms. Maggie, who couldn’t see me until the first week in August, which would be fine because I would be just over twelve weeks, nearing the end of my first trimester. In the meantime, the receptionist would refer me for a scan at an ultrasound clinic.
I went for the scan at the end of that first week in London, eager to get another glimpse of the fetus and make sure everything was OK after the long journey. I was amazed by the ability of reflected sound waves to render an image of the tiny being in my womb. What an immense relief to learn that all was still fine: heartbeat strong and fetus growing. I noticed that the ultrasound machine showed an estimated due date of February 17, 2002. Strange, another day off, I thought, but I didn’t ask. I thought I would wait until I met my new doctor in early August.
As I settled into work in the heart of the old City of London, I felt healthy and optimistic, and looked forward to meeting my new ob-gyn. My New York Jewish mother called religiously to make sure I was eating enough and getting rest. She’d waited a long time for this grandchild and was as excited as I was.
I never got to meet Ms. Maggie. Less than three weeks later, I was in a meeting at my office and knew something was terribly wrong. I had horrible cramps. Everything was tightening. It hurt so much I had to fight back tears, although in retrospect it is hard to know if the tears were from the pain or from the knowledge that something was seriously wrong. I excused myself and went to the bathroom as calmly as I could, and although I was not entirely surprised, I gasped when I saw the blood in my underwear. From the bathroom stall I called Richard in a panic. He calmly told me to call the doctor and to try not to worry. I hastily attempted to clean myself up and make my way back to my office without arousing attention. When I called the doctor’s office, I was told that she was on vacation but that I could see her partner, Mr. R. I hailed a taxi and went straight to the office.
Upon entering his office on the famed Harley Street, as distraught as I was, I could not help but notice my surroundings. A huge wooden desk with impeccable leather accessories. Oil paintings on the walls. A bronze sculpture. No computer. Sitting in a high-back black leather chair amid an array of nineteenth-century antiques, he greeted me politely, asking how I was, did I like London, wasn’t it a dreadful day outside indeed. He reminded me of Peter O’Toole in The Last Emperor. I was cramping and terrified of what had just happened, and not in the mood for British pleasantries. After he chatted with me for what seemed like an unbearable amount of time, he sent me off to the Fetal Medicine Centre for an ultrasound scan without even examining me.
I don’t remember the walk to the Fetal Medicine Centre, which was just a couple of blocks away, and I don’t remember calling my husband to tell him to meet me there, but I must have done both because I somehow got to the center and he showed up some time later. A kind doctor named Dr. Simona took me in for a scan. She didn’t need to tell me anything. Novice as I was, the lack of the constant pulse from the ultrasound screen, coupled with the forced, expressionless look on Dr. Simona’s face told me all I needed to know. There was no heartbeat. There was no baby. I had known it in my office. I knew it now. But why? What happened? I couldn’t bear it. I couldn’t accept it. Overwhelmed with grief, I cried and cried. I was actually shocked by how completely grief-stricken I was. I think I took it worse than I had ever taken anything in my life.
Dr. Simona quietly explained that I’d technically had a “missed abortion” as the medical industry cruelly calls it. The fetus, absent a heartbeat, was still inside me; mercilessly true to its name, a “missed abortion” is even missed by the body of one experiencing it, which continues to feel pregnant. It was of little comfort to learn that miscarriages after seeing a heartbeat were rare and that only 1 percent of women suffer “missed abortions.”
Later, much later, as the haze started to clear for bits of time and I would wander aimlessly around Regents Park, as I often did, or sit on a park bench staring into space, or sit on my couch as was my habit on the many rainy days, or the days when I simply couldn’t get up, I felt guilty. Guilty about all the people I knew who had experienced miscarriages and how little I had understood it. How little attention I had paid. I felt horror at my failure to empathize. I could not possibly have imagined the intensity of the loss a person could feel for a life that had not yet been born.
It took me a few days to want to talk to anyone. At the office, I told only the office manager, Jackie, who was incredibly sympathetic, and my two new friends and colleagues, Susan and Kathryn, with whom I spent virtually all of my time at work. Susan was pregnant at the time, and it was particularly painful to tell her, especially as it was early in her pregnancy as well.
I called my parents and could barely talk to them through my tears. Everyone was shocked. Everyone, that is, except my close friend Kathy, the ob-gyn. I could tell that she wasn’t surprised. When I pressed her, she hesitated and then confessed that she had been worried about me.
“Why?” I asked, confused.
“Because your due date kept slipping. Your due date should never slip by five days. The fetus wasn’t growing properly. They should have told you.”
I was stunned. There were warning signs. She explained that at that stage of early development, a difference of five days was very significant, and that she had suspected that there was a problem with the embryo, very likely a chromosomal problem.
The next part of our conversation, on the other hand, did surprise her. Kathy explained to me that the doctor would most likely be planning to test the chromosomes when he did the dilation and curettage, known as a D&C, but that I should ask about it and make sure that they were definitely planning to do so, so that we could learn from this loss. I told her that Mr. R had strongly counseled against a D&C when he had called a few hours after the scan, and wanted me to wait for the dead fetus to pass naturally, a process that sounded scary, painful, and messy. In addition to the physical horror, I did not welcome the emotional toll of walking around knowing that I was carrying a dead baby. It had been panicking me.
“Whaaaaat?” Kathy exclaimed. “That’s crazy.” She thought I should get the D&C right away. Not only did she think it was emotionally better for me, but we were likely to get useful information about the fetus, and it would have physical benefits as well. I would know that I had been emptied of all the retained products and I would begin to heal and my cycle restart. She emphasized that I was at risk of infection from the dead tissue inside me, and that I had no idea if or when it would come out. We also knew from the ultrasound that the miscarriage, diagnosed at eleven weeks, six days into the pregnancy, likely occurred at approximately nine weeks. Her feeling was that if it had not spontaneously evacuated by now, it was not going to. I called the doctor several times. I practically begged him to do a D&C. He insisted that I wait two weeks. I grew to hate the sound of his voice, his repeated denials of my request for the procedure.
Richard urged me to call another doctor. Kathy urged me to call another doctor. My mother urged me to call another doctor. She had never trusted a doctor that didn’t have a computer. I couldn’t act. I couldn’t explain it, but I felt paralyzed.
Finally, the day came that Mr. R had scheduled the D&C at The Portland. I was relieved, almost strangely excited, to be getting this dead alien being out of my body after two horrendous weeks of waiting. I was not, however, looking forward to seeing Mr. R again. It turns out I needn’t have worried about it. He never showed up. He had a family emergency, and Richard and I waited anxiously for news of what would happen next.
Eventually, a dashing, charming gentleman in a tuxedo popped in to introduce himself. He would be filling in for Mr. R. We must excuse him, he had been on his way to a gala of some sort, when he got diverted to perform my procedure. He would just scrub up and be with us in a jiffy. We were both relieved—he was wonderful. The procedure went smoothly, and when I woke my newest doctor, who happened to be the Surgeon-Gynaecologist to Queen Elizabeth II’s Royal Household, was there, regaling us with his stories. I loved him and wanted him to be my doctor. He politely declined. He couldn’t think of taking a patient from Mr. R. As suddenly as he arrived, he was off, and we were left alone with our reality—sitting in a recovery room in a posh maternity hospital surrounded by mothers and babies when we had just lost ours. It was time to get out of there and refocus on the future.
Several weeks later, I received a fax at my office from Washington, DC. Not to worry about the toxoplasmosis, it said. It was a marker from an old infection and was not a threat to the pregnancy. I didn’t have long to dwell on it. It was September 11, 2001.
Another two weeks later, I received the following letter from Mr. R:
I have now received the Chromosomes results on the products of conception and these show that the fetus was abnormal. The chromosome showed an extra X chromosome which would be the cause of the miscarriage. This should not be repeated in a future pregnancy and is a one-off.
I look forward to seeing you soon.
That was our last communication.
The cause of my first miscarriage at the age of thirty-three was a chromosomal abnormality in the fetus, believed to be the culprit in as many as two-thirds to three-quarters of first trimester miscarriages.2 The most common cause of miscarriage, a chromosomal abnormality in the embryo is generally thought to be a random event resulting from errors in cell division in the egg, sperm, or just forming embryo. This kind of miscarriage is termed “sporadic” (as opposed to “recurrent”), and is experienced by a quarter of all women, the vast majority of whom will go on to bear healthy children.
In my case, it likely wasn’t random at all but due to a whole host of factors that we had yet to discover. Neither was it to be a “one-off” event, as my doctor had assumed.
I. Doctors in the United Kingdom are referred to as Mr., Mrs., or Ms., as the case may be, rather than Dr., unless they have a PhD.