A Father's Grief

It must be very difficult
To be a man in grief.
Since "men don't cry" and "men are strong"
No tears can bring relief.

It must be very difficult
To stand up to the test.
And field calls and visitors
So that she can get some rest.

They always ask if she's alright
And what she's going through.
But seldom take his hand and ask,
"My friend, how are you?"

He hears her cry in the night
And thinks his heart will break.
And dries her tears and comforts her
But "stays strong" for her sake.

It must be very difficult
To start each day anew.
And try to be so very brave-
He lost his baby too.

                                                         --Eileen Knight Hagemeister

Reality bites

Oh, Saturday...you torment us.

Three weeks of Saturdays in grief have shown us a pattern that yesterday we were finally able - and disappointed - to name: there's nowhere to run to get away from what IS.

We came home from the hospital on a Saturday. Unnerved and unsettled, still shocked and with no idea of what to do next, we both reverted to frantic house cleaning. We cleaned for hours, until we sweated, scrubbing and tidying and dusting and vacuuming and picking things up. (Couples house cleaning sprees are very unusual for us. Granted, Paul had been in charge of all things domestic while I was pregnant because I wasn't to lift more than 10 pounds or exert myself in any way, and with so very many plates to juggle sometimes one would fall. He did his best, but by that point our house was a little grungy, not fit for company.) We had company that evening for dinner, but once they left, we were left again with the "now whats".

The following Saturday we went to Westport. It was nice. It was a pre-decided-upon destination.

Yesterday? Oy. We both sat around for hours, inside, outside, TV, quiet, computer. Restless. I felt like we needed to go somewhere. No real thought as to where. Nothing sounded quite right. He needed a part for his truck, so a trip to Cummins south of Chehalis was a good start. Oops. Saturday. Gates closed tight, locked. Now what? Drive. I had the wheel. I drove south on I-5. Earlier in the day I mentioned Portland, but scoffed because I was just off the worst part of the summer cold Paul brought home, that which the night before nearly had me on my knees, so sick. Yesterday was a little better, but still headache-y, coughing, chest a little sore. No other suggestions arose, so south I drove, asking periodically for an itinerary check. Rest stop? Ok, I can do that. Quick diversion, sore bodies from all the sitting (rest area was near Vancouver, so we'd already driven an hour and a half, over 80 miles, in the Subaru that just isn't comfortable anymore).

Then? Drive. Portland's freeway system requires quick decision making, with several branch points. "South to Salem or to Portland?" "Portland." "Ok. Oregon State Fair is going on now in Salem. Calvin's Hats has a booth. Our babies' names are displayed on a card there. We could go to the fair, although that's excessive. How far is it to Salem?" "I don't know, a couple of hours?" "Hmm. Oh, no, should we go to Highway 30 or Highway 26? Quick, this freeway splits right around the corner!" "26." "Ok. This is the way I used to go to Mom and John's when they lived in Beaverton." "This is how we'd go to Tillamook." "Hmm. Want to go to Tillamook?" "I don't know." So I didn't change lanes. I drove. I essentially drove us on a non-stop loop around Portland metro, south past the Rose Quarter, around the south side, and back up north. Suddenly we were headed back through the ugly part of north Portland, back toward Vancouver, WA, across the river. "Huh. We drove all the way down to Portland and now we're headed back north." Yes.

My realization through the quiet of this ridiculous drive: it *feels* like there should be someplace we could go, within driving distance, where suddenly all of the past three weeks would be undone, where we'd find the portal that would take us back in time, where our reality could be different. I'd still be pregnant. The babies would still be with us. Everything would be leading toward a bright future with our children, full of shopping for essentials, finally finding two rear facing car seats that would fit our petite and problematic Forester backseat, finding out the sexes of our babies and musing about names, deciding on a nursery theme, setting up a registry, looking forward to the October baby shower my dear friends were planning, wondering what the holidays would be like - whether the babies would be here already, or I'd be on bedrest with Paul's family celebrating Christmas around our king-sized Tempurpedic, and how we'd possibly (and whether we should) get my hulking body and ginormous belly the couple of hours north to celebrate Christmas with my family. Paul, too, said he's had this itch to go on a nice weekend trip somewhere, feeling like somehow *that* would fix things.

What a bunch of shit. We both realize this can never be fixed. In another part of our lives, following through on this feeling is called "doing a geographic," meaning that you can run, but you can never hide from what ickiness lies inside yourself. For those of you familiar with this phrase and where we learned it, this will all make perfect sense. We could travel to Timbuktu and our sadness and gaping hole in our hearts would follow us. We could take a submarine to the depths and memories of what was supposed to have been would be right there, too.  This is our crappy reality. We don't have to like it, but we do have to accept it.

Our drive didn't end there. Nothing better to do and wanting to stuff our feelings - both of us - (and this also never works, but why stop now?), I continued to drive north, past our exits toward home, toward our former home city of Tacoma. It was a beautiful day, mid-80s and sunny, and Tacoma offers lots of places to walk along the water, people- and boat-watch, plus our favorite Indian restaurant. That's where we finally ended up, walking on the boardwalk at Point Defiance Park, watching the waves and the pleasure boats trying to fish, the crazy kids playing in the water (which hovers in the mid-50s temperature range year round), before crashing into a booth at Gateway to India for a nice dinner that I couldn't really taste because I couldn't really smell...but the textures and basic sweet-salty-sour-spicy bits were divine...and so was the hug from co-owner, CJ, who we hadn't seen in a long time.

Finally satisfied, we drove home. Our adventure took us approximately 300 miles and over 5 hours of driving, all told, in a crazy, crossed over, long, skinny figure eight of roadway.

Given our new awareness, I wonder what next Saturday will bring?

Seeking acceptance

Last week was my first week back in the office (well, partial week, since I only made it Tuesday through Thursday, and Wednesday was the only 8 hour day), and it was pretty ok. I did find the distraction of tasks and co-workers helpful, and really felt the love and support of my co-workers, too, which was nice. I felt anxious about the end of the week, though, since the previous two weeks showed us that, subconsciously, Thursday, Friday and Saturday hold very painful memories that leak out when we least expected them. In anticipation of that, and the fact that I had my postnatal/post-op appointment on Friday, I took the day off.
I did find myself a little weepy on Thursday, and moreso on Friday morning. The appointment, though, was really good. I saw the same doctor who was on-call the night my water broke, the one who ordered the final ultrasound and vaginal swab to confirm amniotic fluid was present (in my vagina, not where it was supposed to be, around Baby A), the same one who admitted me to the Family Birth Center, and who rushed me back for the D&C when the placentas failed to deliver.

She was as wonderful yesterday as she was that horrible night, so very compassionate, searching my eyes for my feelings and so willing to answer every question I could muster through my tears. She helped me find some peace with what happened, based on the answers she gave:

The placentas, both of them, looked very, very normal. There were no signs of clots due to underlying issues with Baby A's placenta; we may never know why it was so fragile.

She didn't take the time to examine the babies closely after delivery because she was more concerned with my health, the amount of blood I was losing and the fact the placentas wouldn't budge. She can't say whether Baby A had a shorter than normal umbilical cord and whether that could have caused the abruptions.

When she examined me in the ER, and based on the ultrasound, my cervix was already changing due to early labor. Hastening delivery only sped up what nature had already started. (This is why expectant management was never discussed as an option for us...it wasn't possible.)

My blood work that night showed slightly elevated white blood cell count, not high enough to say for sure that I had an infection, although it's likely. (My count was 14,200; normal for a pregnant woman is 11,000-13,000).

She confirmed I have four polyps on the outside of my cervix, but agrees that those should not have caused the outcome we had. Blood is an irritant and likely weakened the amniotic sac...but that blood would have had to have been from inside the cervix or the uterus, not on the outside of the cervix. She didn't feel any polyps when she scraped the inside of my uterus during the D&C, but didn't look for a polyp inside the cervical canal. She thinks having Dr. M. do the hysteroscopy in the next month to look for one is a good idea. She said my cervix STILL shows signs of inflammation (stop the insanity!!), so has put me on an antibiotic to try and remedy that. This could also make those four polyps disappear.

As Paul pointed out, one of the biggest things she did is restore a little of our faith in Group Health, our HMO. Both of us were so disheartened with the apparent lack of serious care I received in the three weeks I was with them, but Dr. A. is so *fantastic*...we both really, really liked her in the ER (odd in the face of disaster we'd love the doctor, huh?), and my experience yesterday only strengthens that. However...we know that Dr. M. would have continued to see me, a high risk twin pregnancy, every two weeks throughout the second trimester, then moving to weekly later in the third. Group Health appears to only see even high risk twin pregnancies on a monthly basis until moving to weekly later on...that's a problem. In a perfect world, we'd keep Dr. M. as our fertility specialist and Dr. A. as my OB, but only under the conditions that we'd be seen more frequently and only by her...options we likely don't have through the HMO-controlled process for monitoring OB patients. (I sent Dr. A. a private message last night asking about this through my secure Group Health account. Hopefully she'll respond, but I acknowledged that my question may put her in a difficult position so I understand if she doesn't.)

All these things together help us understand that what happened was a very unfortunate chain of events that led to an inevitable tragic outcome. The babies were just not ours to keep. We have definite worries of recurrence of placental abruptions in future pregnancies and with what happened, I'm even more high risk than I already was. We want to be sure that whoever we choose as an OB, whether Dr. M. or Dr. A., manages my prenatal care very closely and conservatively to help us have the best possible outcome. We do both have faith we'll be pregnant again soon...it's just the positive outcome that is harder to believe in.

The progression/regression dance

This grief thing is a weird experience. The nurses sent us home with a folder full of information on grief and baby loss, including sheets on the stages of grief and a booklet called "When a Child Dies", both of which were helpful. Being able to read about what feelings and emotions - and physical symptoms, too - we might both experience gave us both some comfort.
During our first support group meeting, one week to the day my water broke, I mentioned how odd it was to read about the stages and then realize I'd been flipping back and forth, totally willy nilly, between them, going from acceptance to anger to shock to denial, out of order and in rapid fire succession. They assured me that's completely normal and that it may be this way for a while.

Last week, after the initial shock of Paul's return to work, I had a few days of feeling fairly good during the day. The grief would hit me in the evenings, sometime around or after 5:00 p.m., and come and go until I fell asleep. I commented on how the moments of peace were more frequent and getting longer. I felt a little guilty to be "progressing" through my grief so quickly.

Then this weekend, for reasons I can't understand (except that it's "normal"), I regressed. I went back to those feelings of "this can't be my life" and "I want my babies back", two things I have to just accept as the way things are now. I mentioned this in yesterday's post, but I really did feel lost, like I was looking for my babies and couldn't find them...not a desperation, but a longing and a soul-wrenching missing. I could swear the hole in my heart, the piece my children took with them, was throbbing, aching. Yesterday I felt truly lost. As anxious as I'd felt during the week to have my cycles resume so we can start again, I felt betrayed and angry as my ovaries awakened. I wasn't supposed to have felt those familiar pains, the stretching, until late February or sometime in March, at the eariest. I'm not supposed to feel that now. I was supposed to have been done with that until the twins were safely delivered. I wandered around the house, stared at the TV, couldn't decide what to eat or when, what to do or where to go. I washed the maternity clothes we'd purchased, the ones I had to wear those last few weeks of my pregnancy because absolutely nothing else fit, in preparation for storing them away until next time. In late afternoon we finally got some ice cream, went for a walk down on the docks at a local marina we enjoy, and then went to Costco (because we had to). It was nice to walk and see something else, a distraction, but still, when we returned home, I felt exactly the same. It occurred to me I hadn't cried all day. And then, as if on cue, right at bedtime, it hit me, brief but consuming, that deep, deep sense of loss. I had decided on Friday that I'd go back to work today...I felt bored at home by myself, not sure that being there was really helping me any, thinking being around my co-workers and with tasks in front of me might be a nice distraction. After feeling complete ick and depression all day yesterday and after last night's breakdown, I realized I can't go back today. I'm not ready.

So, this morning I sit, drinking my half-caff, in my bathrobe, tearing up some, still not entirely sure what to do with my day, thinking about going back to work tomorrow. I know, because I tried them on yesterday, that my work slacks - the ones I thought sure I'd probably never fit into again - will fit me fine with the help of my faux Spanx, the ones that kept me sucked in despite the bloat of fertility drugs. My body will be ready to go back tomorrow and try to resume normal life...but will I?

Premonitions

Yesterday Paul and I drove to Westport, Washington, on the Pacific Ocean, to walk around their art festival and check out the beach. It was supposed to be a very hot day at home and we both felt restless, like we needed to be somewhere else. (That's a common feeling in grief, as I understand it.) Westport is very significant in our relationship...Paul has many very fond memories of fishing on big charter boats, most of which still operate today, as a youngster. He usually moors our 25' Bayliner there during the month of August, taking friends and relatives out fishing for salmon and bottom fish (and one tuna trip last year) whenever opportunity presents itself. (This year, he opted to work as much as possible instead, since we were anticipating some financial hardships with the upcoming arrival of the twins. We never could have guessed we'd instead be in mourning during that time instead.)
Paul took me fishing out of Westport on his dad's boat during our first month of dating. I'd never been on the ocean before, let alone on a 17' boat in heavy fog, trying to follow the bright lights of a commercial vessel across the very dangerous Westport bar into open water. It was a huge adventure, and kind of scary, but as we were churning through gigantic waves attempting to keep the rear of his buddy Mike's seasoned boat in view, I had this premonition - "the next time I'm here I'll have a ring on my finger." Two months later we were engaged, and sure enough, the next time I went out fishing, I did indeed have Paul's ring on my finger.

We visited Westport during our first week of mourning. We had no real plan, just needed to get away, out of the house, away from our clouded thoughts. Of course, that didn't really work. Town was a bore, but we made our way to the beach, where I suddenly found myself weeping at the waves. The tears seemed like they'd never stop. We drove south toward Raymond, the very back way home, stopping along the side of the road in view of the ocean as my tears again flowed freely.

Yesterday I was tearless in Westport. Instead I felt like I was looking everywhere for a sign of my babies. I couldn't get them out of my mind (and of course babies and children were everywhere, so that didn't help). (Aside: Paul, who was transfixed by pregnant women during my pregnancy, now obsesses over twins, wondering aloud whether any two children who appear to be related and close in age might be twins. We actually saw a pair of toddler twins on the beach yesterday.) Everything beautiful I saw made my loss more poignant. Paul, and avid rock-hounder, seem obsessed with finding two perfect rocks for our children. (I'm not sure whether he did or didn't...he picked up lots of rocks but I don't know which might be the special ones, and I didn't ask.)

I never used to be a superstitious person, but during our infertility treatments I definitely became one. Yesterday, I had another premonition, just as strong and unshakeable as the ring one I had years ago: we will be back on this beach with our baby in a year. Of course, the premonition was VERY specific as to sex of our child and age range. Paul doubts the sex for some reason and also pointed out my age range couldn't be correct (which is true). However, if we do get pregnant in the next couple of months, then I'll have only been off on the age range but a little bit.

It will be interesting to see what the future holds. I feel very anxious to get started trying again, as does Paul, but we need to wait for nature to restart my cycles and then go in for the procedure with Dr. M. before actually trying again. We both do feel very sure that we will be pregnant again soon. Dealing with those feelings will be a whole other journey.

Pelicans

Windblown

Rough

Of course I would find this, waiting just for me...

Fingerprints

Your fingerprints are on my heart.
Even though I never held your hand –
… you touched me.
Even though I never heard you speak
– you taught me.
You taught me about love.
You taught me about courage.
You taught me about living.
You taught me about loss.
You brought me closer to my loved ones.
You brought me closer to myself.
In the time I cared for you my whole life changed
– never to be the same.
All this from your fingerprints that touched my heart.
Your will stay in my soul forever
– never to be forgotton.
I will always love you.
You are my child.

Tom Krause

From the Grieving Dad's Project website

Managing the "what if's"

In the packet of handouts and materials for newly grieving parents we were given in the hospital were some pieces on the stages of grief. I'd had psychology classes in high school and college and so wasn't unfamiliar with these stages, but it takes on new meaning when you're in the throes of it yourself.

Reading through these colored papers helped us understand that on the day of our children's births, Paul was exhibiting classic signs of shock: sick to his stomach, a squeezing in his chest and inability to catch his breath, and - most noticeable because it's so opposite of normal for him - an unshakeable feeling of cold. (At one point he had four hospital blankets piled on top of him, some fresh out of the warmer, and he was still freezing. My room was kept cool because my post-birth hormones were baking me from the inside out, true, but the "normal" Paul wouldn't have been that cold no matter the temperature.)

I've picked up the packet several times since we've been home and each time I read through it, new things jump out. Yesterday, for me, the theme was managing the "what ifs".

Almost every day one or both of us makes ourselves crazy in the head with wondering whether anything we could have done differently - anything ANYONE could have done differently - would have kept me pregnant long enough to deliver our babies alive and healthy. Lots of women continue pregnancies with placental abruptions and have a better outcome. Many women with preterm premature rupture of membranes, or pPROM, are aggressively managed, sometimes for 10 weeks or more, enduring strict hospital bedrest after 24 weeks with constant monitoring and go on to deliver their kiddos ok. (Reality check: it's not too uncommon for all those measures to still result in an outcome like ours.)

We understand in our heads that the "what if's" are a very normal part of the grieving process, a feeling that we could/should have been able to control what was really uncontrollable, that perhaps if we can figure out exactly what went wrong then we can go back in time and fix the outcome, sort of like the "Choose Your Own Adventure" stories my brother and I read as kids. Sure, maybe I would have been better off not going to my osteopath appointment and then on to the office for a bit in the hours before my water broke...then again, perhaps my water still would have broken that day, or the next, or the day after that. Paul tries to blame himself or our medical team; I blame myself or the medical team. In our hearts it's really hard not to believe that we, the excited parents of these two tiny beings, could have done something to make it all ok. (The shitty thing is many of the symptoms I experienced - and even talked to the OBs about - are considered "normal" when in our case they were symptoms of impending tragedy.) The fact is, it wasn't in our hands, and there's nothing we can do to change our new reality. We must move down the grief path toward acceptance of what is.

Of course, as I (researcher extraordinaire) continue to search for medical explanations of how exactly this all went to Hell in a hand basket, I'm probably seeking to better control the outcome of future pregnancies. We really must lean into Dr. M., the expert, and express our fears of similar outcomes in our quest to become parents, especially since we plan to start trying again for Baby #3 very soon (within the next two months).

The unfortunate events that happened in this pregnancy - two placental abruptions and the catastrophic rupture of our daughter's amniotic sac - are statistically likely to happen to me again. Then again, we don't know why our daughter's placenta was so fragile...was it location? Was it improperly attached to begin with? Did it contain a freak design flaw? And what about that premature rupture of membranes...was it due to blood from the abruptions acting as sand paper over the membrane, weakening it? Or perhaps blood passing through my cervical canal weakened the mucus plug that was supposed to keep bacteria out of my uterus and introduced infection? (Dr. M. thinks there was infection present, enough of one to impact our babies but not me.) Or, heck, was my body just really not cut out to carry multiples and so this "train wreck" of events throughout my pregnancy happened for that reason?

What we do know and appreciate is we don't have to know the answers, and will probably never know the answers. But we can educate ourselves and work with Dr. M. to make sure all that can be done to prevent a repeat performance will be done. There can be no innocence in our future pregnancies; there's just no way. However, we are looking forward and trying to expect and anticipate a completely different outcome...it's the only way to survive this. Oh...that, and me doing my best to help other women take their weird symptoms seriously so that maybe I can help control the outcome of their pregnancies. :)

What Makes a Mother?

I thought of you and closed my eyes,
And prayed to God today.
I asked, "What makes a Mother?"
and I know I heard him say:
"A mother has a baby,
this we know is true."
"But, God, can you be a mother,
when your baby's not with you?"
"Yes, you can," he replied,
with confidence in his voice.
"I give many women babies,
when they leave is not their choice.
Some I send for a lifetime,
and others for a day.
And some I send to feel your womb,
but there is no need to stay."
"I just don't understand this God,
I want my baby here."
He took a breath and cleared his throat,
and then I saw a tear.
"I wish that I could show you,
what your child is doing today,
if you could see your child smile,
with other children who say:
'We go to earth and learn our lessons,
of love and life and fear.
My mommy loved me oh so much,
I got to come straight here.
I feel so lucky to have a mom,
who had so much love for me.
I learned my lessons very quickly,
my mommy set me free.
I miss my mommy oh so much,
but I visit her each day.
When she goes to sleep,
on her pillow's where I lay.
I stroke her hair and kiss her cheek,
and whisper in her ear.
"Mommy, don't be sad today, I'm your baby and I'm here."'
So you see my dear sweet one,
your children are safe.
Your babies are here in My home,
they'll be at heavens gate for you.
So now you see what makes a mother.
It's the feeling in your heart.
It's the love you had so much of,
right from the very start.
Though some on earth may not realize you are a mother,
until their time is done,
they'll be up here with Me one day,
and will know that you're the best one."

                                                                  ~Author Unknown

The Brown Star Story

Not long ago, astronomers found in the heavens gaseous celestial bodies - clouds of cosmic dust - which they think have finally answered the mystery of what exists between the small things in the universe, like planets, and the bigger things, like the sun. They call the cosmic dust "brown dwarfs" or "prestars," because although brown dwarfs have all the same elements to become a star, for some reason they never did.

All stars go on to live full lives, from their hot, bright white dwarf stage to their aged, cooler and dimmer red giant stage. But "brown stars" only go so far. Instead of being born to live a normal star's life, they remain cool and dim, hiding in the heavens, sprinkled in clusters among the other stars, one hundred fifty light years from earth.

But like our babies, their roles in the universe are very important. In fact, scientists believe they serve as a link between the small things and the big things, holding the universe together; a mid-point between the beginning and ending of our universal story.

As we grieve our babies who died before reaching the stardom of their earthly lives, perhaps we can find comfort in the possibility that they are designated for this very special, universal role. Energized by our lives, they are guardians of our memories of what was and our dreams of what someday may be.

As we look to the heavens, seeking answers, we send messages of love to our "brown star" babies.

                                                                                                                    --Kim Steffgen

(from "When Hello Means Goodbye: A Guide for Parents Whose Child Dies Before Birth, At Birth or Shortly After Birth", by Pat Schwiebert, RN and Paul Kirk, MD)

Two weeks ago...

Two weeks ago I was still throwing up at least once per day, usually right after breakfast or right before lunch or dinner. I always hated that I always peed my pants when I threw up, even though often I'd just gone to the bathroom.

Two weeks ago my belly was hard, round, big enough to hold with two hands, one hand over each of two specific special spots. I had been told I was starting to waddle.

Two weeks ago I had an OB visit, requested by me, because my discharge had changed and I was nervous.

Two weeks ago they said don't worry, cervix appears irritated, your cervix is not dilated, your symptoms are normal.

Two weeks ago we never dreamed that within the week our lives would change forever, that we would end up in this place with these feelings.

Two weeks ago I was 13 weeks 5 days pregnant with fraternal twins.

Our babies at 9 weeks 1 day.