Like I Have Time For This?

Many thanks to Robinella over at Not A Stepford Wife for handing me this award. The rules are to pass it on to 7 other people who are nice as well, and who bring something positive to the blogging world.

And ya know what? I think everyone I blog with deserves this award. Seriously. If you’re in my list of Blogs I Like, then you’re a nice blogger and you should have one of these awards for your very own. I encourage all of you to grab a copy of the icon for your blog. I simply can’t imagine trying to pick only 7 people who blog that are nice. There are too many to count.

But because it’s nice to follow the rules, here are 5 bloggers who I’d like to pass this on to: Katherine at Our Report Card, Andie at and the mama, Sara at the Learning Umbrella, Heather at Supernatural World, and Fourmother at Land of our Fourmother. I’d award it to Robinella and Ami, but they’ve already won this thing already.

I’d also like to say thanks to everyone who commented on my twins posts, and who sent me such nice emails instead of commenting. It was a tough week (it always is), but you all made it much easier this year. So, thanks again for being so kind and sweet and teary-eyed, and…well…so nice.

Because it’s true. Nice does matter. A lot.

So, less than 24 hours after I found out that all that pain I’d been in actually meant something, I found myself facing an emergency cerclage. I was immediately whisked away to a private room and prepped for surgery. After the prep work was done and they’d taken a complete medical history, they wheeled me down to a pre-op room, where I ran into (of all people!) my obstetrician. She walked up to where I lay on my gurney and smiled down at me indulgently.

“Well,” she said, all cheery smiles, “it looks like you’re going to be in the hospital for a while.”

I stared at her, thinking how nice it would be to just slap the shit out of her. You know, just slap that cheery little grin right off her face. But then, it just seemed like too much of an effort to raise my hand. I think they must have slipped me a valium at some point. Smart move.

“And I’m going to be assisting on the surgery,” she said next, and her tone of voice indicated that I should somehow find this a Great Comfort. Which I didn’t. I can only imagine how much money she made assisting on the surgery. Thousands of dollars, I’m sure. A nice little week in the Bahamas for her, perhaps.

They wheeled me into the operating room a few minutes later and put me under. The last thing I remember before the anesthesia took hold was this sudden certainty that I was suffocating. I tried to bat the mask off my face and tell them. Finally someone noticed me doing this. He leaned down and said into my ear: “What’s wrong?”

“I can’t breathe,” I said.

“Oh, don’t worry, honey. We’re gonna help you with that.”

And everything went dark.

When I woke up I was back in my room. RegularDad was there. He smiled at me, told me everything was fine, and told me to go back to sleep. This happened a couple more times. Sometimes when I woke up, other people were there. Sometimes it was just him. By nightfall, I was awake enough to have something to eat. They brought in a tray of broth and jello. There is nothing more depressing than a meal of broth and jello in the second trimester.

I found out that by the time they’d started the procedure I was 6 centimeters dilated. But still, they tried. They did 3 stitches instead of the usual 1 stitch. I remain, to this day, their only 3-stitch cerclage. My nice new doctor came in and said that he had to go out of town to take his son to college, but that he’d be calling in to check on me regularly. Then he left.

All through the night and the next day, the contractions kept coming. They gave me more and more medication, but it just never worked. By late evening the following day, I was back in active labor again, and this time there were three stitches in the way. Abnormal labor pains are really, really bad. The nurses on staff gave me a crash course in lamaze, and we waited for the on-call doctor to arrive. While waiting, they inclined my bed to a minus-45 degree angle in the hopes of employing gravity to hold off the delivery.

When the on-call doctor arrived (in an irritated huff, like I’d interrupted his Friday night poker game, perhaps) he made it clear that no attempt to save the babies would happen. That I would deliver and they would die. The minimum gestational age for incubation was 24 weeks. I was 22.5 weeks along. I missed the cutoff by about 10 days.

So, I delivered the babies through three stitches, and they died of asphyxiation and heart failure a few minutes later. The nurses took them away for a while and then brought them back to us bathed and dressed and wrapped in blankets. They took pictures of us, and made plaster casts of their feet. The gave me all the clothes and blankets, and two twin teddy bears.

They told us that because it was technically a live birth and then a death, there was all sorts of procedural paperwork we had to complete, like claiming them on our taxes, having special birth certificates issued, and obtaining social security numbers for them. This was to prevent potential identity theft.

What freak of nature does this sort of thing? Goes through infant death records just to steal their identities?

We went to a local funeral home and had them cremated. And a few years later, RegularDad had a hope chest made for me where I keep their ashes and their belongings.

The nurses told me I could stay in the hospital for a day or two if I wished, but I asked to go home as soon as possible. My nice doctor called me from the road first thing that morning to apologize. He was very upset because he felt he’d given me false hope. I told him that I appreciated all that hope. That I would not have wanted it any other way. I like to think that had he been in town that night, he would have forgone the 24-week minimum and tried to incubate the boys anyway.

And as for my obstetrician? The one who showed up to assist in the surgery at the last minute?

I never saw her again. She never once stopped in to see me after the surgery. Or after the twins died. She never called me. Nothing. A couple of months after it was all over, I received a check in the mail from her office in the amount of ten dollars. It was a refund of my co-pay.

And for those of you who’ve been through this thing before, you know how it went. For those of you who wonder, here’s how it ended:

You woke up the next day, and the world was still there, so eventually you got up and made some coffee and listened to the answering machine when the phone rang, deciding who you wanted to talk to. And then a few days after that, you found the strength to go on a short walk with your husband, and the air was cooling down, the summer was ending, and it was just amazing the way the world just kept on going even though your babies were dead. And then you went back to work and accepted flowers and hugs from good people, and lots of cards in the mail. And one morning you woke up and you weren’t crying when you opened your eyes. And each day, it got a little better.

And a year after that, you found out you were pregnant again and you called up that nice doctor in the hospital, the one with all that hope, and he said, “you come see me now…you don’t go anywhere else but with me” and you just knew it was all going to be okay.

And nine years later, you’ve got an almost 7-year-old and a 4-year-old and a damn good husband, and you don’t cry so much over the whole thing anymore, but you’ve still got your twins in your hope chest, and you’ve got busy days, and quiet nights, and good friends here and there.

And a place you made all by yourself. a good place. a place to tell your story.

A week after I’d been told by two doctors that I was being a skinny little wimp, and still dealing with this terrible pain in my right side, I went in to the local hospital for the big midpoint ultrasound. RegularDad took the day off of work to come along, and we were both eager to see the babies on screen.

The technician did her thing. She asked if we wanted to know the gender and we said yes and she said they were boys. And then she got rather quiet as she began to take various measurements. She got quieter and quieter and then she said she’d be right back and left the room.

She returned a minute later with a doctor: a smiling older gentleman who introduced himself as the head of maternal fetal medicine and then busied himself checking out what the technician wanted to show him, which was of course, vast quantities of amniotic fluid and two twins who were supposed to be identical but weren’t. One was twice the size of the other.

The doctor asked me how I’d been feeling. I told him about the pain I’d been in. He asked if I’d reported that to my obstetrician and I said yes, and then told him the story that I just told you, about the doctors who didn’t think much of my concerns (or my normally slender figure apparently). He patted me on the shoulder and then told us that we’d contracted TTTS and that in our case, the syndrome was advancing rapidly, and that it was time to take certain steps.

Like immediate bedrest. Like consideration of being airlifted to either Utah or Minnesota where I would be a good candidate for a new type of laser surgery in which they’d attempt to sever the crossed blood vessels in the placenta. Or like deciding to stay in state and try the more conventional treatment called Amnio-Reduction, in which they would drain the excess fluid and monitor the babies and see if maybe the syndrome would fade away on its own and the babies would even out. He said he’d treated quite a few cases of TTTS and had had good success.

We liked him, and agreed to try the Amnio-Reduction therapy. He scheduled my first amnio-reduction for later in the afternoon and then sent us out to have some lunch, to regroup, and also to go to my office and hand in my notice. Everyone I worked with was understanding, even though I’d only just started working there a few months ago. After we’d packed up my personal belongings, we headed back to the hospital for my first treatment.

This new, nice doctor met us at the reception area and told us that he’d informed my obstetrician of what was happening, and that she’d asked him to take over my case. He told us that he’d agreed to do that, as long as we said it was okay. We both nodded vigorously and said, “yes, please, absolutely, we want you to take over our case.

And so began my first amnio-reduction, in which they insert a large needle into the uterus and attach it to a pump and begin to drain the excess fluid. Once the needle was in and the pump running nicely, there wasn’t much to do except watch the twins on the tv screen. At one point, one of them kept kicking the needle and messing up the pump which made us laugh and joke a bit about a future field goal kicker.

That first session lasted an hour. They managed to drain one liter of fluid and then had to stop because I started having contractions. They injected me with Trebutaline to make the contractions stop, and the medicine made me shake visibly. Then they sent me home with instructions to return first thing in the morning for another session. I jittered and jived my way out to the parking lot, like a drunk emerging from a bad bout of the DT’s, and RegularDad drove us home, parked me on the couch with large quantities of orange juice and told me not to move.

He spent that evening researching TTTS on the Internet while I watched some cop show I’d never seen before called Law & Order. RegularDad’s research revealed that TTTS more often than not resulted in the loss of the pregnancy, and that babies that survived it often had serious birth complications and defects like heart failure, kidney failure and cerebral palsy. He printed out pages of this stuff and showed it to me, and I just looked away, back to the TV screen.

The next morning, I went in for another reduction. They took out another liter of fluid in another hour, and stopped again when I started having more contractions. They gave me another shot of Trebutaline and then, almost as an after thought, the doctor had the technician check my cervix via ultrasound. I was chatting with RegularDad and his mom who had come along for this visit, feeling good about getting another liter out. My abdomen was noticeably smaller and the pain was starting to fade.

But the doctor and the nurse and the technician got very busy around the computer equipment, and then started paging other staff members and someone suddenly appeared with a wheelchair, and I looked at the doctor and said, “What’s the matter? Aren’t I all right?”

“No,” he said. “You’re not. You’re going into labor.”

Today is the ninth anniversary of the premature birth and subsequent death of my first two children, identical twin boys.

The twins died due to a rare pregnancy complication called Twin to Twin Transfusion Syndrome (TTTS), in which identical twins in utero (sharing the same placenta) get their blood vessels crossed inside the placenta and one twin begins to give all its nutrients to the other twin. Over time, without treatment, this results in one twin who’s basically starving to death, and one who’s so overfed that his blood becomes too thick and he faces heart failure.

The condition is rare enough that research into causes and prevention of the syndrome was only just beginning back in the 80’s and 90’s, and so far, the only thing they’ve been able to determine is that identical twins who contract this illness seem to split somewhat later than what is considered normal.

The condition was rare enough back in 1998, in fact, that my first obstetrician missed all the signs and  symptoms of the illness which I began to show at the end of the first trimester, and didn’t even believe me when I called her office to complain of intense abdominal pain. That doctor, in fact, refused to take my call at all. She told a nurse to tell me to go see my primary care doctor and to get a blood test. I did as she said, and because I had just moved to a new town, I had to pick a primary care physician from a book. That doctor (another woman) took a quick look at me (and I looked about 10 months pregnant even though I was only just starting my 5th month, due to vast quantities of excess amniotic fluid distending my belly), poked me a few times, and then sneered a bit and asked if I was normally a very thin person.

“Yes,” I said. “I come from thin people. My natural metabolism and my history of pernicious anemia keep me thin.”

She sneered again, told me that the terrible pain was “just something I would have to deal with” and that I would have to just get used to it since I was having twins. She told me, in other words, that I had to suck it up. Stop acting like such a baby.

Two weeks later, my sons were dead, and I’d developed an inherent distrust of all female physicians that remains with me to this day.