From the inside out

Content warning: Graphic descriptions of pregnancy loss

We’re looking at a scabby, reddened wound on our dog Sarge’s side — a bite mark from some other moody dog at the park. It’s held together by two small silver staples. Richard looks at it under the light of his cell phone and pronounces that it is healing acceptably. “Injuries heal from the inside out,” he says. “Not from the outside in.” The dog seems fine, as long as he can keep from scratching at it.

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It’s Friday. I am 9 weeks, 3 days pregnant when I indulge in a 2 a.m. bathroom break. I wipe and there’s red-pink discharge on the toilet paper. Sort of mucus-y. Spotting in early pregnancy is either fine or it’s not. At the time of spotting, you don’t know which path you’ve been assigned. You can choose to assume the worst or be hopeful. You can decide that it’s possible to both assume the worst and be hopeful. Pregnancy is the closest thing to Schrödinger’s cat that real life offers.  

I pee again at 7 a.m. and there’s more blood on the toilet paper. There are two pinhead-sized bright red clots in the toilet. A few wipes and the blood disappears.

I go about my day without any more spotting. I talk to my midwife and tell her I figure it’s nothing but that I thought she should know. She says it’s good that it stopped and that I’m not feeling any pain or cramping. I go about my day, working like any other day. I’m glad it’s Friday. I pick Holden up from his dad’s house and bring him home to show him all the Halloween decorations I put up while he was away.

At 9 p.m. I pee again, and there is bright red blood when I wipe, and bright red drops in the water. I think about how I feel in my gut — the physical sensation — and it’s pressure, not pain. It doesn’t seem all that different from how it has been feeling all along since I learned I was pregnant. Is it cramping? How is it that I’m 38 and I’ve been dealing with period cramping for decades and I’m not even sure whether what I feel can be described as cramping? Is this because endometriosis has numbed me to menstrual pain that isn’t excruciating? What’s happening inside of me, really?

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We tried to conceive for about a year, maybe two, and maybe “tried” is not exactly accurate. Some months we tried, some months it tried us. It’s a demanding thing to “try.” I’m working with one ovary and endo scarring and fibroids, and I’m nearly 40. So after a while, we just sort of figured it wasn’t meant to be. We quit trying and just decided whatever would be would be.

In August I felt fully crazy for a few days. Screaming, crying, out-of-body experience crazy. I felt unable to cope and got a prescription for Lexapro to help pull me out of the pit and then a few days later I missed my period.

Suddenly it all made sense. We were really happy. And relieved. My equipment wasn’t busted after all!

We talked about names. We talked about moving into a bigger house. We told just a few friends and family, always with a caveat: It’s still really early. Anything can happen.

Did we really believe that?

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We were a week away from our first prenatal visit. I would have had blood drawn and we would have tried to hear the heartbeat. I can’t decide what’s worse: Having never gotten the chance to try to hear it, or trying to hear it and being informed that it can’t be found.

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On Saturday morning I wake up and I’m for real bleeding, and passing small clots of dark red tissue. It is just like day one or two of my period. My gut aches, a low hum of a cramp getting warmed up. This is different. This is bad. “I think something bad is happening,” I tell Richard, and he hugs me while I cry into his neck. I talk to my midwife again and she tries to walk that tricky tightrope of positive and realistic. But I know the longer this goes on, the more obvious the outcome. She tells me if I bleed heavily — soak through a pad in an hour — for two hours, that I’ll need to go to the ER. (I chuckle to myself that maybe I should go to the ER every month because my period is just that nuts.) We agree that if things stay as they are, we will aim for an ultrasound early in the week.

I go to bed early and wake up around midnight to a gush of fluid and tissue. I run to the bathroom. It feels neverending, but it lasts only seconds. I want to see but I don’t want to look. I cry not because it hurts but because it feels insulting somehow, humiliating. I feel weak and lightheaded. I wonder if this will be the first time I ever faint. I think about how I am going to get back to the bedroom to get a new pair of underwear (the previous pair is a bloody casualty) without passing out or waking Holden up and traumatizing him. There is blood on the toilet seat and probably the floor. Definitely in the laundry hamper. I clean as much as I can, grab a towel, and steady myself enough to make it to the bed to sit down. I ask Richard to get me a new pair of underwear and realize he doesn’t know which drawer is my underwear drawer. In my exhaustion I find this mildly funny. I get my bearings and take the new underwear into the half bath so I can try to clean myself up and construct a makeshift diaper out of jumbo pads. I pass more tissue. I think back to a few days ago when I took a bunch of pads out of my purse, bidding them a fond farewell for the next seven months. I decide that foreshadowing in real life is much less satisfying than in fiction.

I lie back down but can’t sleep because I fear the next gush taking me by surprise. My belly is humming with cramps. I also can’t stop thinking about how I skipped dinner and felt so faint after losing all that blood at once, and that can’t be good. I think about my midwife’s ER comment. I realize I am hungry and nothing will do except a bowl of chicken noodle soup and a grilled cheese. So I get up and make exactly that. I pour a glass of orange juice, which tastes delicious, like nectar. I place my meal on the table and prepare to sit down when I feel another onslaught. I rush to the bathroom and don’t quite make it to the toilet before an enormous clot is out and halfway on the toilet seat, halfway on my underwear. I am crying again but this time I’m pissed off, convinced the universe is trying to kill me and give my husband an unholy mess to clean up. You’re not going to take me too, motherfucker, is the thought that flits through my head. At the same time, “Moose on the Loose” by Farmer Jason is playing on repeat somewhere in my brain, and I am convinced Sarge has his head craned up on the table so he can eat my sandwich while I’m otherwise indisposed. It is an absurd moment, proof that the long arc of the universe bends toward comedy — not justice — at the expense of everything else.

I clean the blood off of everything and myself again. I return to the table and I eat my sandwich and canned soup, and flip through Time magazine’s 100 Most Influential People list. I nod approvingly and try to commit some names to memory. These people seem busy and important and they are living their lives in spite of it all. I drink more orange juice. I decide I’m finally ready to sleep.

I pop a few ibuprofen — which I had sorely missed — and head back to bed. My dreams are full of stressful scenarios involving miscarrying on my wedding day. My brain can work quickly when it wants to, I guess.

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The thing you don’t expect when you miscarry at home is all the time you have to think about what’s happening because it takes so very long. This gives you lots of time to ponder thoughts like, How long has the baby been dead inside of me? Why didn’t I know that when it happened? Was there even a baby in there at all? Why does it feel weird to call it a baby? Is it because it was the size of a grape and completely dependent on me for survival? Why does the word “fetus” have to sound so off-putting, though? Is it because it rhymes with “Cletus”? Which one of my transgressions real or imagined can be blamed for this? How are we going to tell people? How are we going to tell people who didn’t even know yet? Which glob(s) of tissue that slid out of me should I save to mail to Mike Pence, so he can arrange for burial?

And it gives you lots of time to read everything on the internet, even the things you know you shouldn’t read, like British message boards.

It would be nice if there was some kind of receipt — a little ticket or digital readout to tell you what went wrong when your pregnancy cashes out. I respect that the universe needs to stay mysterious to keep its essential appeal, but this one small improvement would be nice. Consider this my attempt to add it to the suggestion box.

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Sunday morning I wake at 6 when Holden and the dogs come bounding into the bed — my customary disorienting wake-up call. The cramping has paused, although I am still bleeding, I can tell. Holden lies beside me and asks when the baby is coming. We hadn’t been planning to tell him about the pregnancy until further along, but I caved a couple of weeks ago mostly so I could get him to quit trying to wrestle me and gut punch me all the time. (Boys.) He had been excited at the news.

I tell him I don’t think the baby will be coming after all. That maybe it was sick or something was wrong, but we won’t be welcoming a new baby in May. He is upset. He says he’s never going to have a little brother or sister. I employ the flower seed metaphor and tell him how glad I am that he grew into a flower, but that not every seed gets to do that. I tell him it’s OK to be frustrated, sad, or mad. He doesn’t dwell on it too long. One small mercy of having a kid with attention issues, I guess.

When I get up, I notice Richard has taken out the trash in the bathroom. I am flooded with such love I can barely stand it.

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In 2016 I had a medical abortion — a scripted version of a spontaneous abortion. In some small way, it has been a comfort to at least know what to expect, once the miscarriage really got going. It removed the doubt and fear of what my body could and would do. The main difference seems to be the length of time it takes to pass “the products of conception.” With the abortion I remember it feeling like one big emptying of everything inside me. With this miscarriage it feels like incremental expulsions spread out over several days. It is like a period but a period on steroids. A big, muscle-bound period that will kick your ass.

There is a mean voice inside of me (that sounds a lot like my sister) that won’t stop telling me this is what I get for the thing I did then. That I had it coming.

I don’t believe it, of course. But the voice is in there nonetheless.

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We spend Sunday playing video games between my trips to the bathroom. I am tired and sad, of course, and both those things seem to come and go in waves. Your body works hard to build the infrastructure to support a growing baby, but it also has to work hard to break that infrastructure down and evict it before it comes toxic.

I send an email to the handful of friends with whom we had shared the initial happy news. We had only just started the process of letting people know. I didn’t get to everyone I intended to. We’d made the gamble that it would be better to have people know if something went wrong than to have to suffer in silence. And as hard as it has been to write those emails and texts, I can’t imagine how this would feel if it was just a big throbbing secret that had torn a hole in our lives but no one knew. In response, we get loving responses, flowers, offers of food and childcare and hugs. The village provides.

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“Seek support” is the advice on every webpage associated with defining miscarriage. Feeling curious about what others felt supported by, I dip one toe in the water of the miscarriage and pregnancy loss online community and feel like I have entered another dimension. Funeral and burial services for your dead baby (or fetus), asking your friends to gather to memorialize the person no one ever got to meet, angel baby gifs, photos of tiny backyard gravestones. I don’t recognize myself or my needs in any of those things. I am experiencing sadness, but some folks are living chasms of longing. It is here, peeking into the reality of those who are haunted by loss, that I taste a strange flavor of gratitude I hadn’t expected. How acceptably and neatly proportional this, my one loss, feels in comparison to the losses endured by so many others. What luck.

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It’s Tuesday. I’m still bleeding and passing large clots of tissue — a truly uncomfortable thing to do — but it’s mostly like a regular heavy period (complete, I will learn in the evening, with the excruciating pain of an extended endo flareup). I took a shower this morning and conditioned my hair. It smells nice. I feel clean. I’m not ready to go back to work yet, even remotely. It’s only been two days. I don’t know how to concentrate on anything, how to be productive. I wonder if I will log this as sick time or bereavement time. I guess it doesn’t really matter. It’s just sand; who cares what we label each grain?

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When it’s quiet and I’m alone, my thoughts worm their way into the soft core of my grief, where I’m mourning not just the loss of a child, but the loss of the chance to have a child with a man who loves me. My primary childbearing and -rearing experience has been with a man whose feelings toward me ranged somewhere between tolerance and all-out loathing, and please believe me when I tell you that this experience does very bad things to your heart and your self-esteem. I’ve been working on repairing those wounds but they are old and deep.

Richard has been the best possible partner for me. He is a kind and decent man who loves me and all my silliness without reservation or self-consciousness. He has been an outstanding step-father and I have been looking forward to experiencing having a baby with this decent human, this nice man who loves me and my son with all his heart, this man who has empathy and never makes me feel shitty about myself. This man who gives me hope. I want to see him hold his newborn, smiling as he rocks a little bundle he swaddled himself (because he is a self-professed A-plus swaddler thanks to his time working in the pediatric ER). I want him to have the transformative experience of holding his child for the first time. I want to give him that. I had imagined that experience would be healing for me. Even the few weeks we had together with our little secret, where Richard got to put his head on my tummy and transmit his love directly into me, through me, were something special. Something I’ve never had before.

I wanted more of that. Maybe that’s selfish, but it’s how I feel.

Now I’m not sure it will ever happen. We’re hopeful, of course. There might still be time. But it seemed so unlikely before. It feels even less likely now. And I have to do the work to be okay with that, should that be the final outcome.

Because injuries heal from the inside out, not the outside in.