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Tuesday, January 06, 2004

I would like to thank all of you who are such a support during this very trying pregnancy. Some of you have brought me food, called me on the phone, emailed me, sent cards, and most importantly, prayed for Elise. Thank you, thank you, thank you. Please continue to pray for her.

I am terrified of my cervix. I don't want it to shorten one more millimeter. I am in bed every second of every day with my feet raised above my head; I'm sort of on an incline to keep as much pressure off the cervix as possible. It is 10 steps from the bed to the loo, and I am afraid to take them. I don't go to the bathroom until it's evident that I'm either to take those 10 steps or wet the bed. And there is no terror like the strain of a bowel movement, so you can just imagine what point I allow myself to reach before taking my 10-step journey to the WC. If going to the bathroom is a life or death issue for me, then imagine getting in a car and taking a nice bumpy, hour-long trip to the doctor's office.

The Dreaded Appointment
We arrived at the medical offices and got a "Front Row Joe" (primo parking space). This was good news to someone who is afraid to take 10 steps to visit the loo. My husband opened the door and went into the lobby to let them know I was coming and would need to lie down and not wait in the waiting room. While I waited in the car I saw a healthy preggo walking up to the door where she was surprised to be met by a friend who asked her how pregnant she was. "38 weeks," came the reply. They both entered the door pleasantly gabbing away.

My husband returned and got me out of the car. The first office door opens into a small foyer with two doors. One door leads to the OB offices while the other leads to GYN. “Li'l Miss 38 Weeks” was still standing there in the cramped foyer gabbing her head off with her hand on the door handle while I was praying that Elise wouldn't fall out on the floor during the gab fest. It reminds me of those absolutely oblivious folks who stop, one in each lane, to have a nice little chat in the middle of the road as people racing to funerals and emergency rooms wait fuming behind them.


"Excuse me.” I said pointedly.

"Blah, blah, blah," said the motor mouth to her friend. "Blah, blah, blah and gab, gab, gab". Translation: "I am oblivious."

I sighed heavily and went to open the door that she still clung to. I rolled my eyes at her as my husband said, "My wife needs to enter the building."

Gabby Pants, finally realizing that other people shared the world with her and were attempting to enter the building, released her grip on the door and got out of the way. I shot all the way through to the exam room, which my doctor entered chuckling to see me lying upside down on the exam table in order to maintain my heels-over-head Trendelenburg position.

"You don't have to stand on your head this whole pregnancy," Dr. Keanu said.

"I will," I informed.

"Don't I know it," said he who knows it.

He looked at the perinatologist's diagnosis/opinion from last Friday and said, "OK, let's do the cerclage."

"Whoa, whoa, whoa!" said my husband and I, "Let's talk about this!"

Dr. Keanu indulged.

We tried to explore the subject in order to determine whether the benefit of cerclage outweighed the risks at this point. The thing with an incompetent cervix is: it's a gamble. Especially with my particular measurements. The bottom line was that we didn't know. We didn't know if we could get by without the cerclage, and we didn't know if she would live one more day after the cerclage was placed. If she makes it four more weeks she will have a chance, a chance. Fifty percent. Better odds than today's. Today she will die if born. One hundred percent probability. She will die.

Dr. Keanu really listened to our concerns. I knew it had already been a long day for him. I tried to personalize the issue.

"Pretend," I said, "that when Elise grows up she will be the one to find the cure for cancer, AIDS, Parkinson's and any other disease you can think of. Pretend that she will find the cure and develop it into one pill, one pill that costs $2. If this were really so, can you imagine how important she would be to the world? Well, that’s how important she is to us already."

Dr. Keanu knows that I get HG, and he knows how bad it is. He is aware that this is our last pregnancy, win or lose. It seems to mean something to him, and for that we are glad. But it's kind of silly when you think about it: Children are not expendable one way or the other. If it is your last pregnancy or if you intend to have 10 more, each time it's your only shot at that child and that child's only shot at his or her life. It's always the "last chance" if you think in realistic terms; it's always so very important.

They measured my cervix again: no change in two days. They pressed on the uterus as though they were trying to squish Elise out, and my cervix shortened a millimeter. Thanks loads. No funneling, just shortening. Shortening increases my risk of preterm labor as we all know and fear.

I asked Dr. Keanu a slew of questions through streaming tears. He confided that if it were he and his wife he didn't know what they would do either. He said that my history with carrying my son to term was good. He said that the contractions that I am having are not. He said that not funneling and not dilating so far is good. He said that losing six millimeters in 14 days of bed rest is not. He said the cerclage could kill her. He said not getting the cerclage could kill her. He said opting for either would be reasonable at this point and what, oh what did we want to do?

Go time. Time for the answer to a life or death question. No pressure here.

"I can't give you an answer," I said. "I'm not going to do the cerclage today, I'll tell you that much. I might not do it at all."

He was not shocked. He was not opinionated, oppositional or cruel. In fact, it seemed rather reasonable to him. Hubby felt the same way. No cerclage. He wasn't comfortable with it. We sort of decided to shift the paradigm a little. We could not get an answer as to whether bed rest or cerclage would give Elise the best chance, so we began looking at it as if she were going to die. If she were going to die, which could we live with: She died because we did something that killed her or she died because we didn't do something that might have saved her? Selfish, but we've so little to go on.

Bed rest is not "doing nothing." For anyone who has ever been on bed rest for months, you know it is SOMETHING. The moments I most look forward to in the day are the moments when I am forced to take my 10 steps to the loo. I'm terrified, but I am sitting up, and my body is so thankful then. The weight is off my back, the painful pockets of trapped air release themselves in a hail of burps and other less pleasant emissions. I can breathe, my blood flows out of my head. All of this relief lasts a glorious 45 seconds. And then the crucial moment comes: the TP exam. If there is blood I will fly to the doctor's screaming for a cerclage. If there is none I will thank God and take five steps back to the foot of my elevated bed where I will slither my body back into position.

Supine dining is no picnic. In fact my appetite has decreased significantly. The moment I swallow, gravity is not working to my benefit. I feel that everything is lodged just in my esophagus. And the toast and cracker crumbs make me feel as though I’m receiving constant, crumby "acupressure therapy." It is like having a sunburned back and sleeping in a bed full of sand and crushed sea shells. Bed rest is not nothing. This is an alternative to cerclage, and for the time being we have chosen it.

Yesterday I felt more peaceful about it than I do today. About an hour ago I had one contraction that was particularly nasty. My uterus became hard as a rock. These are not Braxton Hicks. Dr. Keanu says those don't happen until later in the pregnancy. These are abnormal and troubling contractions. But not so troubling that he did anything about them other than to warn of their unusual quality. It's just one more thing on the plate.

I'm full, thanks. May I be excused?

We hope we made the right decision. It worked with our son, although we do realize this is a different pregnancy, and things have definitely not followed suit.

Please keep praying. Specifically, pray for Elise's survival, for the cervix to stay closed with no funneling, for miraculous LENGTHENING, and also pray for the contractions to stop. Please.

I am 20 weeks and working on my second day. With each passing day we get closer to the dream of a long life with Elise. Each day is a step away from profound grief and a step toward wordless rapture. I can't help feeling though that I am twisting in the wind. I want some sort of oracle, some sort of soothsaying vane to direct my attention to the way this all will end. I feel helpless to save my vulnerable little girl. I desperately want God to intervene and prevent her death. I want the pink, happy ribbon on my hospital door 20 short weeks from now. I do not want, affixed to my door, the dark picture of the weeping leaf.

This is the valley of the shadow, and I have no option but to walk through it. It is scary, it is sad. But I am not alone.


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