Author’s Note: This is a long one. Let’s consider it all the blog posts of the last six weeks wrapped into one. I think you’ll understand. Thanks for being here. –Ev
Some things are difficult to write about because they are too tender, too confusing, too personal. This is one of those things. It’s tender and confusing and personal. I don’t shy away from personal stuff, because I think it’s important in a culture of perfectionist parenting to be honest. We wrap ourselves in unrealistic expectations, protecting our image for others, bullying ourselves into pretending everything is hashtag blessed. Sometimes, instead of finding empathy, we look at our peers and think But I won’t be like that. I’ll be better. It makes me think of this passage from Ezekiel that we read in church recently: “I will give you a new heart and put a new spirit within you; and I will remove the heart of stone from your flesh and give you a heart of flesh.”
I’d been very sure of myself and my plans for the future—arrogantly so. It turns out that in my planning and my rightness, I’d been coating my heart in minerals. And lately I’ve been trying to find that space, that fleshy soft spot, from which I can peel off the calcified exterior, the same way you press your thumb into the soft whiteness of a hard-boiled egg, getting under the skin to take away the shell.
I got pregnant on ParaGard.
ParaGard is an intrauterine device (IUD)—a long-term, non-hormone contraceptive that’s inserted into the uterus. It’s reported to be incredibly safe and effective. There’s a less than one percent chance of getting pregnant.
The week before I figured out I was pregnant, I had had a familiar conversation with my husband, “We are so done. Why did I ever think I wanted three kids?” I looked at families with three kids and thought, What were they thinking? I saw newborns and my heartstrings were still. I had no desire to touch their soft skin or smell their sweet scent. Looking at a newborn, for me, was like picking up a book written in Aramaic: interesting, but unknowable.
My breasts started to hurt. I started to feel nauseous after breakfast. My sense of smell was deafening. I had strange thoughts filtering through my head: Maybe it wouldn’t be terrible if we had a third. Also, I really, really want tacos for breakfast.
I like to keep some pregnancy tests on hand. Before K-Pants was born I ordered a bunch online for about $1.50 per test, and they’d been helpful in relieving anxiety at various times. Recently I ran out. So one morning, after the I-really-want-tacos thought, I took some pee in a tightly sealed Tupperware, dropped the kids off at school, and headed to Dollar Tree. I had it on good authority from the infertility community and the Catholic moms that the dollar store was the place to get your tests.
I was there before they opened, so I stood outside for a minute with another guy, like a half-hearted October Black Thursday stampede. Luckily he wasn’t headed to the pregnancy tests or there might have been a rumble.
I did the test in the car.
It didn’t say I wasn’t pregnant. You may know that if there’s any sort of second line that appears, no matter how faint, you’re juiced. But I was in denial, and I sat there with the false uncertainty. Luckily I had an appointment with my naturopath right afterward. She did another test: “Looks like you’re pregnant.”
The naturopath suggested I call my OB-GYN right away, which was wise, because when I called they said, “How soon can you get here?”
Looking back on this particular Thursday, everything is slow and focused, as if a gentle snow were falling–quieting everything, allowing me to see only a few feet ahead.
I had discussed ParaGard with my midwife the year before and felt good about it. I was most concerned with lasting side effects on my health, which apparently were non-existent. We hadn’t discussed the fact that, according to the ParaGard site, “Although uncommon, pregnancy while using Paragard can be life threatening and may result in loss of pregnancy or fertility.” That discussion didn’t seem necessary, because chances of getting knocked up were so small.
Intrauterine devices do a very good job of making sure an embryo doesn’t implant in the uterus, which means that if you do get pregnant, there’s a good chance the embryo has implanted in the fallopian tubes—an ectopic pregnancy—which is very dangerous. An ectopic pregnancy is not viable, and will eventually rupture the tube, causing serious internal bleeding that can be fatal if not treated right away. The doctor I saw when I came in that day guessed that the chances of ectopic pregnancy were 85%, although I learned later they were closer to 50%.
Because I caught the pregnancy very early—only four-and-a-half weeks along—hormone levels were the only hard information we could rely on to determine if the pregnancy were ectopic. The hCG hormone is an indicator of placental development, and in a normal, uterine pregnancy the level will roughly double every two days. In an ectopic pregnancy, it will behave erratically and level off. I started Thursday at a reading of 275. I don’t know if that was 275 milliliters, micrograms, neurokilowatts. Whatever it was, it was supposed to double. On Saturday I was on a nice walk with my friend Sara when I got the news that the hormone level had gone up to 750. Looking good.
Two days later my husband and I went in to get the results of the next hormone reading, which should have been around 1500. I saw the numbers on a scrap of paper in the doctor’s hand: 275, 750, 866. Not good: 866 was not good.
My midwife had left the practice, and I didn’t have a rapport with my new doctor. “It’s not viable,” she said flatly. Then she gave us information for a drug called methotrexate, a chemotherapy drug that is designed to stop cells from dividing. It would be administered through a shot to a muscle in my leg, and it would eventually stop the embryo’s growth. The doctor left us with the paperwork. I needed to sign it, get my blood drawn to make sure my kidneys and liver were functioning normally, and then the methotrexate would be set up for that afternoon.
Just the week before this I had been pushed to the brink of sanity by my two boys and was feeling affirmed in the fact that our family was complete. Now I was trying unsuccessfully to stop the flow of tears as the doctor described the lab results and the shot of poison. As soon as I’d seen 866, my heart sank. In the days since we’d found out I was pregnant, I’d felt strangely peaceful, as if fairy dust had been scattered over me to calm the storm.
We didn’t want to expand our family. God changed the plan. I was reminded: I am not in control.
The winds around our house have been strangely intense for weeks. We’re surrounded by unkempt trees, so the winds are profound gnarling through their branches. Our trees are beautiful and beloved; but if trees could be feral, then these would be those wild, frothing beasts. They blow and beat their thin branches along the house. Their more substantial limbs break and thump to the ground or land jaggedly in other trees’ canopies. I’m not in control of any of this wild beauty.
Methotrexate scared me. The shock of needing to have it administered on Monday, the 866 day, was too much to handle. When the doctor left, my husband held me as I cried. “What do you want to do?” he asked. “I want to wait two more days,” I answered. I needed time to adjust to the fact that we’d had some powerful magic appear in our lives, and it was turning black. It seemed logical to do one more hormone reading. The doctor agreed to the plan. “But if your hormone levels were higher, we wouldn’t be having this conversation,” she said.
This was Monday. Tuesday my husband was leaving for Thailand on business. The plan to wait longer with my health potentially at risk seemed perhaps ill-conceived, but no choice sounded good.
That night I started to have more intense pain on my right side. I knew the tube hadn’t ruptured because I was told that pain would be very, very intense—unmistakable. But the additional pain scared me, especially with my husband leaving the next day. We had decided from the beginning that my health was the number one priority, and all decisions needed to be made with that in mind. Suddenly I was in increasing pain with my husband going out of town in the morning, and I could have already taken the methotrexate. At least then I wouldn’t be sitting with mounting uncertainty. I called the doctor, and also my friend Karen who is a high-risk OB-GYN. We made a plan for me to go in the next day for an ultrasound.
It turns out I would be at the doctor’s office every day that week.
On Tuesday the ultrasound showed maybe something in the tubes, maybe something in the uterus. Totally inconclusive: It was still too early. On Wednesday, I was mentally exhausted and ready for methotrexate. The hormone level would come in, I expected, and it would tell us not viable again. But it went from 866 to 2200. “Well, I don’t know what to do with you,” said my new doctor (I had broken up with the first one). “It could be ectopic or it could be viable. We can’t say.”
I had prayed for a miracle. Now this miracle seemed scarier than the methotrexate. My husband was out of town and I needed to wait two days to get another reading. In the meantime, my fallopian tube could potentially rupture. My rising anxiety was telling me I was being cavalier with my health and putting the whole family at risk.
“Do you feel comfortable sending me home?” I asked the doctor. “No,” she said, “but what are we going to do? There’s a chance this is viable, you live close to the hospital, and you have good care set up: You’re not going to bleed to death at home.”
This was vaguely reassuring.
I called my friend Karen. “We have to consider that the 866 reading was erroneous. It wouldn’t be unthinkable to request another ultrasound for Thursday.” She felt like if it were ectopic, something might appear, and if it were normal, there could possibly be a sac in the uterus.
Thursday there was a gestational sac in the uterus. Thursday’s doctor—I’d been put with whoever could fit me into the schedule—was nonchalant. “I would not have recommended methotrexate,” she said. “And looking at your readings, they are potentially normal given that hCG really doubles every two to three days. Come in for your hormone readings tomorrow and Monday, and then another ultrasound a week from now. You could have a normal baby in there.” I was in shock. “Things could be normal?” I asked, “Because on Monday I was told to take methotrexate. Now things could be normal. You could tell me that you’d seen fairies or pigs on the ultrasound and I would believe you.”
She laughed. I broke up with the second doctor and went with this one. Plus, this one had a kickass nurse. I also started referring to whatever was growing inside me as the fairy pig.
Friday I got my blood drawn again. The level had gone from 2200 to 3700, and by Monday it was 9600.
Starting on Tuesday after my husband left, my friend Mana came with me to all my doctor’s appointments. She also talked to an OB-GYN friend of hers, who made it clear that in a situation like this, when you get pregnant on an intrauterine device and discover the pregnancy early, it’s basically a waiting game. You use all the data you can—hormone and pain levels and ultrasounds—to slowly figure out what’s happening. It reminded me that all will be revealed in time. But also you could start to bleed internally and require emergency surgery while your husband is in Thailand.
A week later I was walking around with my fallopian tubes intact, and my husband was home. We went in for the follow-up ultrasound: there was a yolk sac in the uterus, and nothing in the tubes. Two weeks later we had the last acute ultrasound. There it was—a fast little heartbeat palpitating on the screen.
As my husband and I waited after the ultrasound to meet with the doctor we chatted about mundane things, and tears kept soaking steadily into my shirt. The little fairy pig was here, had a heartbeat.
I could start to lightly release the tension on the knobs that had wound the violin strings of my soul to their tautest state.
I am now in the second trimester of this fairy-pig pregnancy. God keeps reminding me that I am not in control.
Last-but-very-very-not-least: I am so grateful…
For Hannah, who was the first person after my husband whom I told I was pregnant, because—as I knew she would—she greeted the news with jubilation and sympathy. And then she came and sat with me at my last blood draw.
For Mana, who rearranged her schedule to come with me to every doctor appointment while my husband was out of town. She knows more doctors and nurses in my clinic than most patients do.
For Leslie and Brita and Vivien, who picked up my boys from school and brought them to their houses whenever I had an appointment.
For my sister Hillary, who changed everything in her life in order to stay with me and organize support until my husband got back.
For my family, who came and helped and brought food and took the boys and did whatever needed to be done.
For Maru and Maddie, who spent nights at our house and played with my boys.
For my friend Lauren, who has an incredible wealth of early pregnancy knowledge and also a humorous and wise take on everything.
For Karen, my friend who is an OB-GYN who specializes in high risk situations. She made all the overwhelming details accessible, and helped guide me through difficult medical questions.
For Brandon, for marrying Karen and setting up an instant conference call when I asked.
For our priest, who prayed with me and gave me the image of being bathed in golden light. That is a powerful image.
For everyone else who offered prayers, empathy, and support along the way.