Bear with me while I take us back in time, all the way back to the beginning of last week. I am a big fan of the Ineffable Now and letting the dead past bury its dead and all that, but if I don't tell you what transpired between then and now I am afraid that you will have no idea what the hell I am talking about. Some of this you have heard before, so excuse the repetition but... narrative flow, baby. It is all about the narrative flow.
Last Monday the Crappiest Ultrasound Machine in the Universe (TM) showed that the embryonic heart rate had dropped from 107 bpm the previous week to 93 or something equally disturbing. Immediately following this ultrasound I met with a new obstetrician, my old obstetrician having fled the little office of horrors with the coming of the new year. The new OB saw nothing wrong with a declining heart rate and started scheduling me for CVS testing, per my initial request. In his world I would not have been seen by a physician, phlebotomist or phax machine until I showed up at the perinatalogist on April 12th.
So, either he truly believed that embryonic heart rates do not need to steadily increase during the first trimester (in which case he is utterly incompetent and I pity his poor parents who must have been so proud when he got into med school) OR he was patronizing me (meaning he knew that I would most likely lose the pregnancy but did not feel he needed to share this tidbit with me.) Now, in the general scheme of things I can imagine scenarios in which women (some women) might prefer to just go about their hapless selection of nursery accessories until they miscarry one horrifying day, but I AM NOT ONE OF THOSE WOMEN. Among other things, if I do not do genetic testing on this pregnancy I will never know what caused embryonic demise, thus I could be dooming myself to any number of terrible reproductive decisions going forward.
So I jettisoned Dr. Loser and made appointments for another ultrasound and a consultation with a new new obstetrician. That was last Monday.
Tuesday I went for the ultrasound and saw that the embryo measured 6 weeks 2 days (rather than 6 weeks 6 days or, if you wanna get REALLY specific 7 weeks and 2 days per transfer dates) and the heart rate was 74 bpm. You are no doubt too busy to google this for yourselves, so I'll just go ahead and tell you that the miscarriage rate for this situation is in the neighborhood of 100% (+/- two standard deviations to allow for the possibility of, like, divine intervention.)
Therefore, Wednesday morning found me leaving the new new OB's nurse a message so rambling and incoherent it could have been scripted by the Unabomber. Thankfully a nurse called me back within a few minutes and, even more thankfully, she was willing to overlook the fact that I was not technically a patient of theirs. She listened. She comprehended. And then she put together a reasonable course of action.
To wit: an immediate hcg check followed by a repeat on Friday (last Friday.) Once Friday's result was available I would meet with the doctor Friday afternoon and most likely have an ultrasound with them.
I cried because she was so nice and so efficient and so responsive. Then she cried because I was crying. I doubt this sort of thing happens with a proctology practice but I do not want to be guilty of gender stereotyping so I will leave the possibility open. Still, I doubt it.
Wednesday's hcg level was 13000 and something. What does that mean, you ask? Nothing.
Friday's hcg level was 16000 and something. What does that mean, you ask? Well, nothing much. It confirms that the pregnancy is not developing properly but it also indicated that it most likely will not be going anywhere on its own anytime soon.
I met with the new new OB Friday afternoon and fell madly in love with her. She is so SMART. And she has a sense of humor. And she was a genetics counselor before she went to med school and, you know, we have genetic issues so that is a nice synergy right there.
We talked and talked and I explained my whole obstetrical history and we put together a long term plan and a short term plan and heavenly choirs sang.
Unfortunately, their ultrasound machine was in use and we waited and waited and the person did not leave. So my new best friend suggested I just come back in on Monday. And that sounded fine to me because, as I told her, I was certain that there was no longer a heartbeat to be found and I was equally certain there would still not be a heartbeat on Monday. So, it didn't affect my weekend one way or the other and it was too late at that point to schedule anything further so I would have had to come back anyway.
Which brings me to my appointment yesterday. By the way, if you were paying attention you will notice that I went to either an obstetrician or a radiologist FIVE times last week. This is why my insurance company hates me and their entire actuarial staff camps at the mailbox each month, waiting for me to miss our premium by a day so they can cancel me. Ha! Fat chance! Not with my soon-to-be-patented Toast Rack Chronological Bill Payment System.
The first thing I heard upon arrival is that my doctor was not there, as she was out delivering some other patient's baby. Mazel tov.
The ultrasound tech brought me back to the machine and tried to enter the relevant information into her SUPERSUPER Deluxe Sono7000.
Date of last menstrual period? I did IVF, so, well, I guess you could say BLAH, but the last ultrasound said BLAH but the one before that gave a due date of BLAH so...
Is this your first pregnancy? Ha! Sorry! No. Ha HA HA! It's my millionth. Not really, but, it feels that way sometimes. No, this is number 8. Wait, sorry. 9. Ninth.
I decided to cut to the chase and told her that we were not going to see a heartbeat so chop chop let's just move it along, shall we?
So she started the abdominal scan and immediately said, "Oh but there is the heartbeat right there."
And I looked at her screen and then I looked at the WALL-MOUNTED PATIENT VIEWING SCREEN (how classy is this place?) and sure enough blip blip blip. I sighed really loudly and said that it was probably just me. And she said no, she was seeing it not hearing it. And I said, yeah, something like this happened three pregnancies ago and it looked like the embryo had a heartbeat but actually it was a vessel of mine that we were seeing. And the embryo was just a disintegrating string of tissue.
Whereupon she measured the heartbeat and it was, more or less, exactly what it was last week. In the upper 70s. Then she measured the embryo and it had grown a week to seven weeks exactly.
At which point I screamed Medic! and one of the partner OBs came in. She agreed we were all looking at a heartbeat. She agreed it was really fucking slow. She asked if I was taking baby aspirin and I said, uh, well, I WAS taking all this stuff but then, um, the last ultrasound practically showed X's for eyes so I, er, stopped taking everything.
Which is when she punched me in the leg, pretty hard, and said, "Oh just take the damn pills! And come back on Thursday."
So I did. And I will.
On an editorial note, I would like to add: am I supposed to be learning patience? Is that the Great Lesson in this? I assume I must be missing something, otherwise I would not have to keep repeating the same miserable experience over and over again. I have never heard of a heart rate just staying ludicrously low and steady while the embryo grows. It was REASONABLE to expect the embryo to have died since the last ultrasound. Why is the cosmos fucking with me? Any suggestions?