08 July 2013

We'll See Part I

Before I even begin to process the reality of the past few weeks, let me first say very clearly and unequivocally that I dreamed it before any of it unfolded.  I have witnesses to this, too, because I told more than one person about my vivid dream: "I dreamed I had another C-section, I could feel the pain of walking in my belly. Except this time I recall that there was a risk that I would die, that I wasn't getting the same care, namely that I did not have those blood pressure cuff-like things on my calves that inflated and deflated, just someone at the end of my bed squeezing my toes. I still had to walk around and do stuff, so I thought I might die. And my baby was nowhere to be found."
I had that dream the night before I learned I was pregnant, the night after vivid dreams of adolescent male lions loping around my front yard. I am not usually one to have vivid dreams but definitely  had many when I was pregnant with Selah. I told my friend Luana and my acupuncturist Jeff about these dreams; then the next day I "felt very strange indeed" at work and decided to take a pregnancy test, which turned out to be positive. I was shocked.
Gabriel and I were not trying to get pregnant, especially given the big move to Miami that we were in the midst of executing. Knowing that natural/cosmic timelines work on a scale that is not our own, I still accepted and welcomed the pregnancy and for a couple of days could perceive a male energy interacting with me, trying me on for size.  I had some symptoms, but was not nearly as sick or tired as I had been when I was carrying teeny tiny embryonic Selah.
A day after learning that I was pregnant, I began spotting and then to bleed a little more earnestly, though I experienced no pain.  I felt confused by the signals my body was sending me, though I felt that I had lost the pregnancy and began to feel grief surface.  I had a "wait and see" attitude towards the pregnancy, but still it is impossible to corral the natural hopes and daydreams that come along with knowing that you have the potential for a new life in you (one that is wanted, anyway - I can't comment to the alternative, though emotions and experiences are just as valid either way).  This is why I completed my project for the New York Zen Center's Foundations Program on "Contemplative Care in Early Pregnancy": the time period for a woman between learning that she is pregnant and starting regular medical care (approximately one month for most) is rich, volatile, precarious, and often spent in relative isolation.  This was not really an exception, despite my own work and attention on the matter! I feel grateful for my close sisterfriend who knew intimately of my work and had the capacity to help me hold my experience in the way that I had framed, how I would like to continue caring for others.
It was not lost on me that this entire experience unfolded analogously to the Zen story of "We'll See...", that every seeming positive or negative had its absoluteness turned on its head almost immediately, so that all I could do was to pay attention and suspend judgment.  I'm pregnant, great! I'm not pregnant, terrible! It's ectopic, terrible! You don't have to have surgery, great! You do have to have surgery, terrible! You are going home, great! You are going back to the hospital, terrible! On and on and on, with surprises and kindness at every turn.
So I bled painlessly, a slow prune juice trickle not a red eruption, for several days and let my body try to figure things out. I saw my acupuncturist with hopes that he could "read" what was actually happening with me, as he had known that I was pregnant with Selah before I did. He was equally baffled. Together in treatment we invited my body to regulate itself, but did not try to force an outcome of staying or leaving.
After about five days of ambivalence (turns out you can be "a little bit pregnant"), I called the OB/GYN office who invited me to come to their office right away for an ultrasound and appointment. The ultrasound showed an ectopic pregnancy near my right ovary, about 4 cm in diameter.  The ultrasound tech and radiologist looked me square in the eyes and very compassionately told me that they saw no heartbeat and that the mass was not a viable pregnancy. Being that I had already come to terms with this eventuality I did not feel the need to cry or break down on the ultrasound table, but I give plenty of credit to the tech and doctor for their professionalism and kindness.  My immediate concern was for my health.
When I met with the obstetrician, my first question for her was to characterize for me the seriousness of the condition. Her first response was, "untreated, this condition could threaten your life." And when I inquired about options for treatment, she outlined either immediate emergency surgery or a low-dose chemo drug that would (hopefully) dissolve it but also still held the possibility of rupture and surgery, not to mention birth defects should I become pregnant again during a specific window of time. Okay, rock and hard place.  She said "surgery" and I immediately started to cry out of fear. Again, to her credit, she moved from her "doctor's seat" at the desk in front of her computer to the seat next to me and handed me tissues, acknowledging "Yes, this is scary."  Every single moment of authenticity and humanity resonated with me during this entire process, and I am grateful for them.
The determining factor, I was told, was the level of pregnancy hormone (HCG) in my system, and whether it was high enough to determine the course of treatment: too high, and it would mean surgery right away; moderate and increasing, the methotrexate is recommended; moderate and falling, we may get away with not having to intervene immediately and instead watching and waiting with the caveat that any pain would require me to go to the emergency room immediately.  I rolled the dice and spent the afternoon by Jamaica Pond with my reiki healer sister goddess Luana, who helped me to regain equilibrium, power, and good sense as we waited for the number to be determined.  After being told not to drink or eat at all since my 10 am appointment in the event that I required emergency surgery, I decided around 4 pm that I'd have a grapefruit and some water and pick Selah up and go home.  If they really wanted me to come in then things would be moving with a little more sense of urgency (yes, I called 3 times to get the results and even harassed the lab at Brigham & Women's who told me that they don't deal directly with patients, only with doctors).  They called on my way home and told me that I was at 1772. Not high enough to cause alarm, not low enough to be calm.  I would be in for blood draws about every two days to track the rise or fall of the hormone in my system. Day 2 it fell to 1502; day 4 to 1446; day 6 to 998; day 8 to 863. I was still not in pain.  The doctors I saw and spoke with offered cautious equanimity.
July 3rd I went for a repeat ultrasound that showed the mass in the same place and position, 2 mm larger.  With the hormone levels decreasing, the doctors chalked the moderate growth up to an internal breakdown before breaking apart and being reabsorbed. I was okay with this. Selah and I went to our friends' annual Thirth of July party, played and ate and watched fireworks on the beach in Swampscott.  So glad we had that festive time together.
On the morning of July 4th, I got out of bed around 8:30, went to the bathroom, and came into the kitchen to drink half a glass of water. Selah spilled some of her water that she was getting from the refrigerator spigot, and as I bent to wipe it up I felt pain in my abdomen. Real pain. I went back to the bathroom and sat on the toilet in a sweat, just getting my bearings and seeing if it was something that would pass or exacerbate.  I returned to the living room where my dad was bustling between grilling peppers for the family pool party he was planning to attend in Albany that day and tending to the lawn. "I don't feel so good," I said as I sat in the recliner, trembling and sweating.  "Do you need to go to the doctor?" he asked.
"Do I have a couple of minutes or do you need to go now?"
"You have a couple of minutes."
He disappeared to clean himself up before planning to take me to the hospital, and I realized that I couldn't stand up straight and was starting to feel woozy beyond woozy. I called an ambulance.
Operating automatically, I managed to stagger into the bathroom to brush my teeth and comb my hair (priorities!), packed my toothbrush and phone charger into my bag, told my dad I had called an ambulance and went out front to sit on the steps and wait. I texted a few people, including Gabriel and my friends who knew what was going on, and then not one but two ambulances appeared along with a police car and fire chief truck from Westborough, the town over.  There were many nice uniformed men standing around me, asking me questions.  I did my best to tell my story accurately and was ushered into one of the ambulances for a trip to Metrowest Medical Center. I wasn't sure about going to this place as I had the opinion that it might be a little too podunk and wasn't sure about the level of care I could expect.  Again, "we'll see..."
During the ambulance ride (my first ever!) I had the benefit of having the paramedic intern from Quinsigamond Community College trying to insert an IV in my hand during a particularly bumpy stretch of route 135. The July Effect loomed for me as I said, "ouch. ouch. ouch." as he kept missing my vein. They pulled the ambulance over so that he could have a steadier hand to try out his handiwork. Both of them really were keen to offer me medication for nausea, something for pain, but I refused both. I wasn't nauseated and I could handle the pain. My capacity to work with pain is threatening to medical professionals, this theme surfaces continuously.  It is not me trying to be tough, it is not me trying to be a hero, it is me putting my practices into play.  Why do I practice if not to use it when the opportunity arises? The savvy ones acknowledge what I'm doing and trust that I know my body; the insecure ones try to convince, cajole, or bully me into "staying ahead of the pain."  Over and over again. But I expect it, so I know how to set my boundaries and what to say to short-circuit power plays.
We made it to the hospital and I rested in the ER bay, attended to by a kind older nurse named Cissie. She reminded me of my own Auntie Skipper, my grandmother's sister, and so I felt secure. She asked me questions, removed my jewelry and put them carefully in a bag, and tactfully recommended that my dad take Selah back home shortly after they arrived to keep me company.  "You're going to be here for a while, they should probably come back later," she cautioned. That was her way of knowing that whatever I was about to experience could be traumatic for a four-year old to witness, and to create an atmosphere that was supportive for all of us.  Dad and Selah left when I was feeling like I was going to pass out, and my best friend The Midge arrived shortly after.  She sat with me as I talked to the ER doctors and they prepped me for surgery (you have to have surgery - great!) and walked with me to the OR, giving me smooches on the forehead before I went in to meet with the anesthesiologists.
[To Be Continued]

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