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<html>
<head>
<meta description="Five Years of Miscarriages" />
<title> Miscarriages </title>
</head>
<body>
<blockquote>
There are moments that the words don’t reach
There is suffering too terrible to name
You hold your child as tight as you can
And push away the unimaginable
The moments when you’re in so deep
It feels easier to just swim down
</blockquote>
<p>
Since 2014, Sandy and I have been trying to have a child. We know now for certain that
we will not be able to.
</p>
<p>
In 2014, shortly after having been married by Elvis in Vegas on our way to Palo Alto,
we started attempting to become pregnant. We had read the books, made all sorts of
decisions. We'd use a midwife. We'd do a home birth, maybe a water birth. It didn't
take long, Sandy became pregnant. We knew from some close friends who had a miscarriage
before their first successful child that we should wait until 12 weeks to say anything,
because that's the period when things are riskiest. We went for the ultra sound.
</p>
<p>
When you go for an ultrasound, you expect to see something that doesn't actually look
like anything recognizable but which the technician will inform you is an embryo. If
you're lucky the first time, you might even hear a heartbeat.
</p>
<p>
What you don't expect is for the technician to keep clicking around, measuring what
looks like an outline, and eventually tell you there is nothing there. You don't
expect to have a Blighted Ovum.
</p>
<p>
Incidentally, you also expect the ultrasound technician to have some shred of empathy.
But what you might start to learn is that the things you expect are not in concert with
reality.
</p>
<p>
A good friend of mine told me that the Zen Buddhist definition of suffering is the mismatch
between expectations and reality. I don't know if it's actually Zen Buddhism or not, but
I'll go along with the definition at this point, because all of the ways in which reality
was diverging from our expectations weren't not suffering.
</p>
<p>
We waited for it to miscarry by itself. When that happened, it being our first time,
we went to the ER and learned that the ER at Stanford Medical Center is the
Marc and Laura Andreessen Emergency Department. It was very nice, but it turns out
there isn't much they can do. The on-call OB, however, happened to be EXCELLENT and
became our new OB.
</p>
<p>
That's good, because this set of unexpected reality wasn't done with us. Sandy had a DNC
to clean things out, and in the follow up blood testing her HCG levels weren't going down
properly. That's because the little Blighted Ovum had decided to become Gestational
Trophoblastic Disease. Essentially, some of the cells embedded themselves in the uterine
wall and continued dividing. Like Cancer.
</p>
<p>
The treatment, also like Cancer, is chemo. Methotrexate injections. The last injections
actually happened during the Paris OpenStack Summit, so we got to experience getting
chemo injections in a foreign country. Sandy has a wonderful story about how this affected
her experience of L'Auberge Du Pont De Collonges, but I'll leave that to her.
</p>
<p>
That was a lot to deal with in Palo Alto. We moved back to New York.
<p>
After chemo for your gestational trophoblastic disease, you have to wait a while before
trying to get pregnant again. We had <em>literally</em> just start trying again, which is why
it didn't occur to us that Sandy was pregnant. (we now know that "my boobs hurt" is a great
indicator, and doesn't mean "it's time to go bra shopping")
</p>
<p>
I was in Mexico City for OpenStack Days Latam 2015 when I learned that Sandy was pregnant
again. The way I learned is that on my way to the venue in the morning, I got a phone call
from Sandy's good friend Shantel telling me that Sandy was in the hospital, having been
taken there in an ambulance the night before after rupturing a fallopian tube. I booked the
next flight back to New York and rushed back to New York.
</p>
<p>
Sandy almost bled out. By all accounts, given the amount of blood she lost to
internal bleeding, she should be dead. Woodhull Medical Center in Bed-Stuy is not nearly
as pretty as the Marc And Laura Andreessen Emergency Department. People in the area call it
"Woodhell". The blinds on the door to Sandy's room were broken and were partially replaced
by a sheet that had been tacked up onto the door. This is, of course, because Bed-Stuy is
a neighborhood full of brown people who don't deserve the same medical care as the folks
at Cougar Night on Sand Hill Road.
</p>
<p>
But here's the thing. The doctors at Woodhull are fierce, and Sandy is alive. If I ever get
billions of dollars for no good reason, I'm totally going to endow a Sandra Trahan Emergency
Department in Woodhull.
</p>
<p>
After this, I'm going to be honest, it starts to run together for me. We had some more normal
miscarriages. We went and saw Hamilton. We moved to Dallas. We saw a heartbeat once, then
miscarried, which was life reminding us that we weren't numb yet and that it was still
possible to punch us in the face.
</p>
<p>
Then we hit a patch of, for the first time, not immediately getting pregnant as soon as
we started trying. So we shifted our focus to IVF.
</p>
<p>
If you haven't been lucky enough to go through IVF, it's almost as much fun as Gestational
Trophoblastic Disease, but with more needles. As part of perparation they sent Sandy to
a hemotologist, where we learned that she has two clotting disorders. This means if she gets
pregnant we have to start injecting her daily with blood thinners. But before we get to that
we get to inject her with all of the IVF drugs.
</p>
<p>
If you haven't been lucky enough to need to inject your partner with multiple needles
every night, I don't have anything clever to say. It sucks. It was, of course, worse for
her.
</p>
<p>
This is followed by the egg-extraction surgery. We got three almost viable embryos. None
of them took. Our IFV doctor noticed some scar tissue around the cervix from all the DNCs
we'd had to do and scheduled a surgery to take care of it before the next time. During that
procedure the doctor discovered some tissue in the uterus that had been hanging out there
since the last DNC. Kind of like the first time except this time with less cancer.
</p>
<p>
Incidentally, our FIRST IVF doctor did a bunch of expensive tests, found elevated levels
of inflammation (maybe actually due to the extra tissue laying around?) and recommend Sandy
try removing Gluten from her diet.
</p>
<p>
Gluten.
</p>
<p>
By this point, we didn't have any remaining insurance for additional IVF, which isn't not related
to all of those expensive and pointless tests, but also isn't not related to having an almost
offensively but definitely absurdly low lifetime cap on our IVF benfits. Why would anyone properly
fund women's reproductive health? We decided to take a break.
</p>
<p>
Nope.
</p>
<p>
Right as we were starting to settle in to the idea that this just might not work out for us
and start the process of healing, we got unexpectedly pregnant. Now that the extra tissue had
been removed, we were back to being very good at getting pregnant. Due to Sandy's blood clotting,
this meant blood thinner injections. Nightly. In the belly.
</p>
<p>
The injections hurt a lot, and produce purple bruising. The blood thinners have impacts on
Sandy's psyche.
</p>
<p>
It should come as no surprise that even with the blood thinners, and even with the extra tissue
being gone, and even with the gallons of prenatals ... we once again miscarried. You'd think
we'd be old pros at this this time, but it was one of the more cruel ones. We had just about
hit a point of healing and acceptance, then we were given hope we weren't looking for again,
then it was once again dashed.
</p>
<p>
That was last year.
</p>
<p>
This year, in early February, right around our three-year annivesary of moving to Dallas,
we got accidentally pregnant again. We'd been EXTRA cautious, but that apparently doesn't mean
anything. We knew it wasn't going to work, because let's be honest here -- but we also knew that
due to the clotting disorder we'd need to give Sandy blood thinners for a pregnancy that wasn't
going to be viable or else she ran the risk of throwing a clot and stroking out.
</p>
<p>
Acceptance comes at strange times, and it was at this point that we realized that we were, in
fact, done. We did not have it in us to fight this uphill battle anymore. It was time to choose
to be Child Free, instead of simply suffering being Childless.
</p>
<p>
Oh wait, did I mentioned we'd moved to Texas? Let me tell you something we all know, but which
I have recently been reminded of first hand.
</p>
<p>
Texas Lawmakers hate women.
</p>
<p>
Not only is it illegal for our OB to perform an abortion for us on a pregnancy we know isn't going
to be viable and that we don't want without waiting until we're far enough along to possibly
hear a heartbeat, once we wait for that magical humiliating moment of going in to the ultrasound
clinic with all of the happy pregnant women and getting our non-viable ultrasound result,
it is then illegal for our OB to prescribe the chemical abortion pills in the way that is actually
effective as recommended by the WHO. (incidentally, if you're in Texas and your OB tells you to
take the pills orally, ignore them. Taking them orally carries a side effect of nausea and is also
less effective. Take the vaginally. Or, rather, go Google what the WHO recommends and do that.)
There is no valid reason to take them orally, unless your goal is punishing women who have had
the temerity to become pregnant inappropriately.
</p>
<blockquote>
If you see them in the street, walking side by side, have pity
They are trying to do the unimaginable
</blockquote>
<p>
We are now Child Free.
</p>
<p>
I got a vasectomy, so that we don't have any more accidental pregnancies,
what with them being life-threatening for Sandy and all. I can report that my procedure was sort of like
going to get a latte, because I'm a dude, and of course medical science is going to figure out
how to make my tiny procedure as absolutely painless as possible.
</p>
<p>
I am at peace with our choice and happy about what's next. I still have all the emotions.
I obviously have some anger. I'm devastated that I won't get to raise a kid. I'm sad that I won't
get to give my parents grandkids, which is doubly-hard since I am an only child. (I'm also adopted,
because my parents also had issues so they can empathize with our plight as well as anyone.
Yes, we looked in to adoption. No, we don't have the emotional strength left to do it)
</p>
<p>
I'm also grateful that I have a partner I love and who loves me. I am excited to continue
to build our life together. It's not the life we expected to build, but I accept the life that it
actually is.
</p>
<blockquote>
There are moments that the words don’t reach
There is a grace too powerful to name
We push away what we can never understand
We push away the unimaginable
</blockquote>
<small><em>Lyrics from "Quiet Uptown" by Lin-Manuel Miranda</em></small>
</body>
</html>