Tangled (15 months)

This week was such a juxtaposition of emotions: fear, anguish, hope, anxiety, sorrow, anger, guilt.

Thursday and Friday were yet another anniversary of the events that broke our hearts: the deaths and births of our babies. Babies who should be sitting up, eating solids, babbling, taking toys from one another at nearly nine months old. Those thoughts are so heartbreaking to me. My heart hurts.

This was also my monitoring week for this IVF cycle, and that in itself has been a roller coaster of emotions and such a whirlwind of appointments and details that it's made grieving for the life we're supposed to have had, and for our babies we miss so terribly, and for the girl I used to be and will never be again, really hard. It's difficult to feel those feelings when current life is overwhelming everything else.

On Wednesday I went up to Seattle for my stim day 5 (SD5) monitoring appointment. The appointment was at 7:15 a.m., technically 1 hour and 45 minutes away. I gave myself two hours, stopped and got gas (losing about 5 minutes), but with heavy traffic from Tacoma to downtown Seattle, I barely made it on time. I got up to the 4th floor and had to pee so badly it was making my stomach hurt, but I had to check my watch: I had two minutes before my appointment. I took them, literally willing myself not to pee my pants as I frantically unfastened them (in the interest of full disclosure, the zipper no longer stays up on for some reason, and so these pants are partially fastened with a twist tie, a bitch to undo when you're doing the potty dance). I made it into the clinic right at 7:15, glanced at the whiteboard and saw that only Dr. H. was on (Dr. Z.'s female colleague, who I'd never met), head full of anxiety over what this ultrasound might reveal (this is where things started going sideways in December and April), and was whisked back into a room to have my blood pressure taken.

Not surprisingly, it was high: 137/104. The medical assistant asked, "Are you on medication for your blood pressure?" I said no, that my blood pressure has always been great, but I was a little stressed at the moment. The assistant said she'd try again before I left.

The ultrasound rooms are teensy, and nearly as soon as the medical assistant left, she was back with Dr. H. and the day's IVF nurse, Jeri Lynn (who, thankfully, I'd met the week before). Crowded into the room, they started the ultrasound of my ovaries, screen turned away from me (Dr. M. has a little screen that patients can see during all ultrasounds), calling out numbers for recording. I had eight follicles total...but only seven worth measuring, and six were in the right ovary. My left ovary, which had harbored 4-5 pre-antral follicles just two weeks before (when my large ovarian cyst was discovered), had only one. WTH?? My endometrium (uterine lining) was great, as per my usual. Dr. H. noted that three of my follicles were substantially larger than the others...not a good sign. She said she may need me to go home and get my Cetrotide out of the fridge and bring it back to work with me, in case she called and needed me to start my shots right then. (That would be another hour I was not at work, since I live 35 minutes from my office, but ok...another hit to my annual and sick leave.)

I went next door, and Dr. H. came in by herself to discuss my blood pressure. Things quickly began to unravel when she implied that losing the twins could be the result of my high blood pressure. I objected, saying my BP was always totally normal, even during my pregnancy, when the increase in blood volume a multiples' pregnancy brings on could have caused concern. I explained the (several) factors that led me to feeling stress that morning. I felt like she wasn't listening. (I fully admit to baggage around doctors not listening to me, given that my concerns were dismissed multiple times during my care with our (former) HMO's obstetrical department...the one that insisted I wasn't really high risk, that bleeding was normal for twins, and that it was fine for me to have my first appointment with an actual OB at 16w6d - which is bullshit and still makes me SO angry to this day...and has caused pretty severe trust issues for me with medical professionals.)

Dr. H. said she wanted to consult with UW's expert in maternal hypertension and see what "he" thought, that "he" might want to see me by the end of the week. Ruh roh. I said, "Can I ask who "he" is?" She said, "Dr. E. He's amazing." I replied, "That may well be, but I have a fellow twin babylost mama friend who had a very, very bad experience with him. Dr. Z. agreed this man can be very abrupt. Frankly, tomorrow is the 15-month anniversary of my daughter's water breaking, and Friday is the 15-month anniversary of our twins' delivery in the hospital, and I am not going to see someone who may be insensitive to me at this particular time." She objected, but I stood my ground. She said, "I understand your concerns, I do, but I want you to be checked out so that if there is a problem, we can get you on blood pressure medication before egg retrieval. I have to tell you, if you show up for egg retrieval next week with high blood pressure, the anesthesiologists may not play. It would also be good to have another opinion on your pregnancy and loss history, since so many factors were in play that it's hard to tell what could have caused it all. If your blood pressure was an issue, we want to fix it now so that you can have a healthy pregnancy." She left to consult with a female colleague of Dr. E's...and the tears started.

By the time Jeri Lynn came into the room to discuss Cetrotide shots, I was on the verge of full meltdown. I shared with her that it's an anniversary week, and she got it immediately and was very apologetic. She stayed extra long with me...exactly what I needed. By the time Dr. H. came back in, I was under control. Dr. H. said the maternal fetal medicine specialist (MFM) that she consulted with agreed I should be seen, and that they would be in touch to let me know when. I finished up with Jeri Lynn, got my blood drawn for estradiol testing and got the heck out. (Aside: just my luck that I would hit I-5 just as it was being closed for the passage of the First Lady's motorcade on its way to the airport. Awesome. Tick tock...my leave is leaving me so quickly!)

I shed so many tears on the way back to my office for so many reasons. (Another aside: I risked it and went straight back to work, deciding instead that if I needed to start Cetrotide that afternoon, I'd absorb that time into my lunch hour rather than burn yet another hour of leave...a good call, as it turned out.) The Maternal Infant Care Clinic called me that afternoon to let me know they reserved a 3:20 p.m. appointment slot for me to be seen the next day, Thursday. My head (a dangerous place to go alone) started telling me that maybe my blood pressure was to blame, that maybe my blood pressure would disqualify me for egg retrieval next week, and that maybe this would be yet another time where my pregnancy and loss story were dismissed. (In hindsight, holy cow...shut UP, brain!)

Thankfully, Paul was able to come with me Thursday, and he was in full goofball mode, which really helped keep the mood light. (It’s hard not to smile when your husband says, as you get into the car to leave for a two-hour trip in unknown traffic, "Step inside my rocket ship!") We arrived so quickly (thank you, carpool lane!) that we had plenty of time to get some lunch and be mellow. The MFM also ran 40 minutes late, so we sat by the fish tank in the lobby - on the opposite side of the room from the other pregnant patients. (By the way, this is the same office where we had our near-perfect NT scan with the twins in late July 2011.) The MFM's nurse was my age and sassy, which I liked (and needed). The appointment itself was fine...and despite my thinking that this MFM (who we both really liked, Dr. C.) was going to want the full run-down on my twin pregnancy and loss story, she didn't! The appointment was solely focused on my blood pressure history and risk factors (slim to none). My BP at the start of the appointment was 137/84, but at the end it was 118/76. (HA!!! I told you so!) While there's not enough evidence to suggest I have hypertension, Dr. C. said I could have pre-hypertension, so she wants to see me again on the 18th, when I will leave a 12-hour urine catch sample and some blood in the lab, and come armed with a list of my daily BPs. Cool.

I went back up to UW again yesterday, Friday, for my SD9 monitoring appointment. This time, I allowed 2.5 hours travel to my 7:30 a.m. appointment, but ended up an hour early.(Seattle traffic is so unpredictable!) My BP was only slightly elevated (137/83). I now have 8 good follicles in the running (16mm, three 15mm, two 13mm, two 11mm, plus a 7mm that won't likely do anything and a couple of tiny ones that definitely won't). This is the most I've ever had! As instructed, I gave myself a Cetrotide shot (brought it in a cooler on ice), got my blood drawn (E2 476, awesome!), and headed back to Olympia for another stressful day of work. I don't go back to Seattle again until tomorrow morning (SD11 monitoring), and then I'll likely go back Monday (hopefully to receive instructions to take the trigger shot that night), Tuesday (for E2 blood work), and then Wednesday for egg retrieval. Paul and I both feel so hopeful now that this cycle appears (so far, knock on every wood we can find) to be going well...and hope can lead to expectations, and expectations can bite you in the ass. (No pressure...not like this is the first and only time we'll drop this kind of money for a fresh IVF cycle, the last time I have a chance to conceive my genetic child(ren)...oh, wait, yes it is. Damn. Danger, Will Robinson...)

Interestingly, with all of this going on, I completely forgot this is the first time the 4th and 5th days of the month landed on Thursday and Friday again...those two days of the week that haunted me for the first several weeks of grieving. Yesterday we received the quarterly newsletter for one of the two support groups we've been attending for over a year...and Aliya and Bennett were left out of the August "remembrance" list. Nice…happy 15-month anniversary to us. (I actually left a note on the group's Facebook page so they could know they made a mistake. They've had our forms for over a year. Not cool.) Then, reading a friend's blog about their special anniversary, I felt pangs of jealousy as I read about the great support they still receive from friends and family nearly 2 years later. We don't really have that, we've really never had that, and it hurts. It's not unusual for babylost parents to be forgotten (or at least not acknowledged) at special, painful times, but still. Then last night we had a late dinner out with my uncle and his friend, who are down here to hunt this weekend, and the co-owner walked in; he was my ER nurse the night my water broke. We've seen him several times and I've never mentioned it, nor did I last night ("Hi, remember me, your neighbor who you had to do a bladder scan on to see if it was full enough to finally, six hours later, perform an ultrasound the night our twin daughter's water broke?"). Seeing him during an anniversary was surreal. (Thank God he was not wearing scrubs, just street clothes!)

I feel guilty to have my heart and head split between remembering and missing my babies (and our former innocence) so, so terribly, and hoping beyond hope that all our efforts, all my shots (four drugs per day now), the daily headaches Paul and I have from the Cipro we're both taking, the hours of work leave I'm burning to get to and from appointments (8 hours this week alone), will bring us another pregnancy, one that maybe this time will last to term (or close to it) and result in our third - first living - child, and, fingers crossed, enough healthy frozen embryos to make a second (and maybe third) living child.