I don’t spend a lot of time thinking of or talking about my third miscarriage.  There were so many things going on in my life at that point that the loss was gobbled up by other events.  But while the miscarriage itself isn’t crystalized in my memory; it represents a turning point in my life and my infertility journey.  It irrevocably fractured my resolve and changed the nature of my grief. 

My first job after university was as a Teach for America corps member in Houston.  During my first-year, one of my students came to class with a kitten inside her jacket.  It happened that I was leaving early that day, so I took the kitten with me intent on giving it back to her once I spoke to her parents and confirmed they were alright with her keeping the animal.  However, destiny determined she should be mine.  I named her Pepper and she was my first fur baby – a tiny, tenacious, grey ball of fluff.   She liked me best of all the humans, and there were times I might have chosen her over humans in my life.  She was one of my comforts during sadness.  

After our second loss, we tried to get pregnant again for a year with no success (more on that in a later post), so we made the decision to see a specialist.  The same doctor had been independently recommended to me from two friends, which I took as a sign, so it was her with whom I made my first appointment.  However, I have learned after the fact that we started the medical phase of our journey rather atypically. 

The doctor we saw was quietly intelligent, active in research and education, but specialized in reproductive immunology – a field not well accepted withing reproductive medicine where most doctors focus on reproductive endocrinology.  That our immune system plays a role in fertility and pregnancy is well recognized; however, evidence that immune therapies improve pregnancy outcomes is mixed.  Thus, usually patients arrive at reproductive immunology when all traditional treatments have failed them, not as a first stop. 

Regardless, she took us through the standard infertility workup – a battery of blood tests and physical examinations – as well has her own investigative protocol, and diagnosed me with a myriad of clinical and sub-clinical conditions that potentially contributed to our infertility and losses.  Then she started me on a LOT of medicine.  I began taking four different prescriptions, multiple supplements, and daily injections. 

Ever the over achiever, I adhered to her regimen to the extreme. She told me to limit my carbs, so I stopped eating refined sugar all together. She explained we were trying to reduce my inflammation levels, so I cut out dairy and gluten and began taking turmeric and milk thistle and other things that Dr. Google proclaimed to be anti-inflammatory. I proactively stopped consuming caffeine. I began a daily yoga regimen. I viewed my body as a problem that could be solved. I was convinced that being the perfect patient would result in a perfect pregnancy. And after one surgery and six months of treatments with her we were finally ready to do our first “natural cycle.” (I still find it hilarious that what we were doing was considered “natural.” We were told to have sex at a prescribed time after taking prescribed medications – there was nothing “natural” about it.)

Our prescribed time happened to be while my husband was supposed to be out of town. We were in the process of moving from Chicago to Seattle, and he had planned a two-week, cross-country road trip before starting his new job. We could have waited another month to try, but during fertility treatments, a month feels like an eternity. Every day it felt like I was closer and closer to the 35-year-old cliff when I would become medically “high-risk,” all my eggs would dry up, and I would never be a mother. So, much to my husband’s disappointment, I forced him to truncate his trip and bring me along. I’m pretty sure we got pregnant in a hotel somewhere in North Dakota. I didn’t care. I could manage his displeasure. It would all be worth it when we had our child. The positive pregnancy test only served to reinforce my conviction.

A month later, two things brought from my high horse to my knees:

1. My mom called to tell me that Pepper had stopped eating.  (We had left our cats with my mom while we stayed in corporate housing and looked for a permanent place in Seattle).
2. I started spotting. 

I flew back to Chicago on a Monday afternoon to see my doctor and the vet. 

The week commenced hopefully.  I reduced my blood thinners and stopped spotting.  Pepper showed no signs of infection and her liver panel came back clean.  But in the days that followed she still wouldn’t eat.  The vet treated her empirically with antibiotics while I hand fed her baby food and pumpkin puree, but nothing helped.  On top of that, my Thursday blood test indicated a probable miscarriage.  I told my husband he needed to fly back as well. 

On Friday, I had an appointment with our doctor which he attended.  The ultrasound confirmed a miscarriage.  On Saturday, Pepper lost the use of her hind legs, and we took her to an emergency vet where she was put to sleep. 

I can’t think of these two events separately because they are so intertwined.  Nor can I say which hurt worse because all I felt was deep aching and emptiness.  In the days that followed I remember regularly rubbing my chest in a misguided effort to massage the pain in my heart.

I completely broke.  I had done everything my doctor told me to the letter, but the outcome was the same.  Moreover, I felt horribly responsible for Pepper’s death.  I berated myself for not having recognized her reduced appetite, for not taking her to the vet early enough, and for not giving her enough attention over her final few weeks.  I felt I had failed her and failed myself.

It’s hard to tell which feelings and which reactions resulted from which loss.  But the result was a complete abandonment of rationality and self-control.  I went from conscientiously dieting in order to control my blood sugar and inflammation to what I can only describe as rage eating.  I aggressively binged.  I ate chocolate and sugar and cheese and salt.  I ate to the point where I felt sick and then kept eating.  I felt so betrayed by my body, so angry at God, and so exhausted from months of self-discipline, that I took back control forcibly, if unhealthily.  I was a rubber band stretched too far, and I snapped back.

I also obsessed over my cat.  I wrote lists of things I loved about her, made slide shows of her pictures, and had her image printed on a large pillow.  I think I did some of these things because I found it easier to grieve the loss of Pepper than my pregnancy.  She had lived, after all.   I could do all the “normal” activities.  I could memorialize her remains.  I could talk about my memories.  I could transition from having her to not having her.  I have never been able to do that with my miscarriages although many women do.  Some women have memorials for their lost pregnancies, or paint pictures of their “angel babies,” or save ultrasound images, or purchase baby shoes and teddy bears to help formalize the loss and move on from it.  Those actions never felt authentic to me, and maybe that’s why I struggled so much.  Pain is like poison; we need to suck it out of the wound, or it will fester. 

I wish I could go back in time and give myself a hug.  The sentiments in the above paragraphs are meant to represent how I felt at the time. But I think it’s vitally important for me (and my readers) to recognize some of my false narratives: 

• I was single-minded in my efforts to get pregnant to the detriment of my marriage, mental health, and personal schedules. My priorities were clear, but my life was unbalanced.
• I tried to overcome infertility by rigorously controlling everything I put into my body, but it simply does not work that way.
• I felt weak for failing to maintain my self-control after the miscarriage; but sugary, fatty foods release dopamine, which is a brain chemical that makes us feel better. I was deeply sad and just trying to feel better.
• I thought I was responsible for Pepper’s death (who most likely died of lymphoma), when there was nothing I could have done to prevent her from getting sick. And even if I had known of the cancer earlier, I’m not certain treatment would have been the right option.
• I disenfranchised my own grief, by minimizing it and refusing to memorialize my pregnancy losses. But in doing so, unintentionally prolonged my recovery.

I must learn to be kinder to myself. We must all learn to be kinder to ourselves. There’s a Garfunkel and Oates song I find absolutely hysterical called 29/31 in which the same woman sings about her life perspective from two years apart. The 29-year-old is filled with hope for her future, while the 31-year-old thinks her life is over. The rosy view of the 29-year old is how I felt when we first started trying to conceive, while the fatalistic view of the 31-year-old is absolutely how I felt each passing month of fertility treatments. But I wish the song had an epilogue. Because the 31-year-old woman’s perspective will shift again, and again, and again. So, while it’s laughable how much our world view can change in such a short time, it’s also critical to remember this current view will not last.