I was not super patiently waiting for my miscarriage to actually go ahead and happen. I did not particularly like the "natural miscarriage" option but I liked it better than the surgical option or the pills that cause massive bleeding and cramping option. I had a doctor's appointment on Friday. It started inauspiciously when I arrived 5 minutes early yet somehow didn't get checked in until 10 minutes after its scheduled start time. The lady in front of me had been late by an hour but called ahead and they told her they could squeeze her in. When she got there, they couldn't squeeze her in. Then someone else was late because they had gone to the wrong office location. Finally I was checked in, only to wait 20 more minutes in the waiting room. Then I was escorted back to my favorite place, the scale, by a nurse who chastised me for being sick with a cold. She then let me know they didn't have a room for me so I could wait on the chairs in the hall. This was where I waited last week for the ultrasound that confirmed fetal demise, so yay for that. I waited a while. I saw my NP go by on her way to tell exam room 3 that she had a vaginal infection. Exam room 3 turned out to be a sullen teen mom, which I found out when I was eventually taken to the very same room. Nurse Chastise came in to take my bp and said "How are you doing? You're not DEPRESSED are you?" Because that certainly wouldn't be an appropriate response to losing a wanted pregnancy, no. Nurse C then asked if I have any pain. I told her a few minor cramps and such. She asked what they would be on the 1-10 scale. I said maybe a 2. She made a rude noise and said, "that doesn't even count, I'm putting 0." then she asked what I was there for, anyway.

Once we got that out of the way, NP Amanda from last week came in to see how I was doing, and what I wanted to do given that nothing was happening. I asked her for her recommendation, and she said she would "do something." This would either be tablets to dilate the cervix or a D&C. I was still pretty violently opposed to either option but the pills were just not sounding fun. ("Nurse practitioners prescribe them, but doctors don't really like them," said Amanda. "Because people end up in the ER with heavy bleeding and it's the doctors who have to treat them.") So that, combined with my lack of success with assisted cervical dilation during my labor with Patrick, made Amanda think I would be a good candidate for a D&C.

It was at this point that Nurse Chastise stuck her head in the room and said that James had arrived and could he come back. I may have muttered something unladylike. What had happened was that James had gotten himself the day off work to go to my appointment with me. I did not particularly want him there, as he tends to take things harder than me, and then it all goes downhill from there. Also, I wasn't sure if things were going to get physical, and that was just not going to be pleasant. Anyway I had told James that it would in fact bother me a little bit if he came to the appointment, but that if it would make HIM feel better or give him peace of mind, then he could come.

"You don't have to have him come back here," said Amanda, who was clearly trying to be kind. I said he could come back. She briefly gave him the rundown of the previous appointment, how there was no heartbeat, etc, and how we had just gotten to my options. Amanda seemed unconcerned about any risks of infection if I chose to wait but again outlined the options. Eventually, I grudgingly agreed to the D&C.

"The ultrasound last week was conclusive, but we can see if there's any room in the schedule, to give you another look," said Amanda. I didn't need to see it again, had seen it for myself, didn't really WANT to see it again.

"I'd like to see it," said James.

Turns out, ultrasound was fully booked. We went to the waiting room. And waited. Eventually we got called back. Dave from last week was there again. "Why exactly are we here?" he asked.

"He wants to see that there's no heartbeat," I said, pointing at James. Dave was much more sympathetic to James at this point than I was. He said he wasn't sure how much he could see, at this point, with it having been so long, but hey! There was my uterus, and there, at the bottom, was a little pile of something that had disintegrated and looked even less baby-shaped than a week previous. James started crying. Dave passed the box of tissues over me. He took us on a brief tour of my bladder (empty) and my ovaries, and my uterus from bottom to top then back again. He sent us on our way, with his condolences.

At check out, they have no idea what to do with me. Someone will call.

That afternoon, I get a call from Dawn, who's trying to schedule my procedure. She says it will be next Friday, that's the soonest that Dr. A can do it, and Dr. A wants to do it, and she wants to do it at the surgical center and that's the only day... I can't do anything but accept, but somehow that's the straw that breaks the camel's back.

I don't want to do it on a Friday. I like Fridays. I won't get to miss more than one day of work, and if I have to be in this shitty situation, then I might as well get some time off work from it. And the Super Bowl is Sunday and I don't know what recovery will be like. Then I find out that my deductible has doubled so it will cost me even more money to have a procedure that I don't want. Basically I am cranky and scared. More than anything, I want to be able to have at least one sibling for Patrick. I am not handling the fear thing well.

Weekend. Retail therapy. I buy four pairs of shoes. Nothing happens to advance the cause, as it were.

Until Monday evening. First there is a rather impressive clot. Then the cramps. I decide that natural childbirth is really not for me. But I am actually happy about this whole development, since it means no D&C! My body is getting it right for a change. James and Patrick go to bed. Sometime around 9:30 I feel a pop and then I start bleeding. And bleeding. And bleeding. But the cramps have mostly stopped. After an hour or so of, oh let's use words like pouring and gushing, I start to get concerned. I am still feeling ok. I thought it was slowing at one point and took a shower, and then tried to clean up the bathroom a bit, but suddenly it was back. I check online. It says if you can fill a pad in under an hour, you should call your doctor. I can fill a pad in under 10 minutes. Hmm. I keep hoping it will stop. It doesn't. Around 11:30 I wake James up and tell him I think I might need to go to the ER.

But we don’t go to the ER right away, no. James is still abed and mostly unresponsive and I don’t want to have to wake Patrick anyway so I tell him I guess I’ll give it a few more minutes. But a few more minutes later, there’s no sign of anything changing for the better. He calls his sister for advice, then makes me talk to her. She has had two miscarriages and said that it was heavy bleeding with clots, but not THAT heavy. She thinks that maybe I should go in if it hasn’t stopped by the morning, but I could always call my on-call OB line.

So James calls the OB, and apparently my OBs are not on call that particular night – they share call with another practice – so we get a callback from Dr. C at Durham Regional Hospital. She says if I’ve been bleeding heavily for two and a half hours, then I should probably come in, just to make sure I’m not anemic.

We wake Patrick up and drive off to the ER. Yay. I actually start to feel like I’m going to pass out so I have to sit with my head between my legs. On a trash bag, because I haven’t lost enough blood to stop caring about ruining my car’s seats. Once there, I look bad enough that the lady at the desk yells for a wheelchair, and I’m pushed back to my little curtain. Sadly it’s nothing like Grey’s Anatomy. The person who checked me in at the desk is the one who pushed me back, and she hands me a gown and tells me “everything off below the waist” which I probably could have figured out on my own. Then my ER nurse comes in and starts an IV. She mentions that the “ghetto hospital” doesn’t have “chuck pads” (I think that’s what she called them) which would have come in very handy in my (gushing blood) situation. She takes my blood pressure (107/62 – lowish for me) and leaves the cuff on, where it will do nothing for quite some time. (A half-hour? An hour? I don’t know.) She says she will go ahead and start me on a bag of fluids because that’s probably what the doctor will want. Patrick charms the nurses and gets some goldfish and some teddy grahams. He is wide-eyed and unsure but not crying.

Eventually Dr. C, who was the on-call doctor that James talked to, comes down. She has pulled my records, and goes over them a bit with me. “So you didn’t know anything was wrong, you just went in for your regular appointment on the 20^th?” She asks if I’ve been passing clots. I say yes, big ones. She asks, “How big, exactly? Because people have different ideas.” I say the size of my fist. “That’s big,” she says. She asks if I’ve seen any tissue. I haven’t. (Though I mean, I was sitting on the toilet so it could have just gone away. I’m not sure how much tissue there is, exactly.)

She says she’ll do an exam and then there are three possible scenarios. One is that I’ve stopped the heavy bleeding and completed the miscarriage, in which case they’ll do an ultrasound to make sure everything passed, and then I can go home. Two is that I’m still bleeding because the retained products of conception are stuck right behind my cervix, and she can just grab those with her handy forceps and then we’re done. (I don’t know if I would have gotten an ultrasound in that scenario.) Three is that I’m bleeding uncontrollably because my uterus still doesn’t know what the fuck it’s doing and has just decided to bleed like a stuck pig rather than get rid of any products of conception. In that case, I get to go straight to the OR, do not pass go, do not collect $200, and get a D&C. (An emergency D&C? An urgent D&C? Who knows.)

Let’s all take a minute and guess where this is going.

We actually have several minutes to speculate, because back at the ghetto ER, they don’t have any ring forceps. I don’t know what these are but I later find out they are implements of torture. Or they could be used as such, I mean. Dr. C is frustrated. The nurse looks confused. You would think they could just call up to the maternity floor or something and get them since presumably they use them up there. I don’t know. We wait a while. Finally they procure some ring forceps and proceed with the exam. They actually make some sort of equipment for this ER situation (which the hospital has, for once), in which you can have portable stirrups. This is great in theory but not so much in practice, Dr. C tells me. My assigned portable stirrups have a broken desk lamp with them. I’m sure it’s not actually a desk lamp, but that’s what it looks like, and it’s supposed to be attached, so, you know, the doctor can see what she’s doing in there. My nurse says she will hold it for the exam.

I think it’s an accepted fact that these types of exams are extremely unpleasant if you’re in labor. But by the time I had one with Patrick, I already had an epidural. So I’m just going to go ahead and say this was the worst exam ever. I don’t think I whimpered out loud but I wanted to. I know I flinched a couple of times. That shit hurt. “Okay,” says Dr. C, “I’m going to stop bothering you now. There’s no evidence that any tissue has passed, so we’re going to take you up to the OR.”

At 2 a.m., I have to sign the consent forms. The biggie is that there’s a chance of perforating the uterus. I’m still more worried about scarring but at this point none of it really matters. I mean, what are you going to say? “Oh, hey, thanks. I mean, I WOULD do this D&C, but there are these risks, so if it’s all the same to you, I think I’ll just take my chances on bleeding out.” Yeah, not so much. I do notice the consent form I’m signing is for a “suction D&C” which I take as a good sign. The handy BP cuff informs me that my BP is 92/50. I’m feeling woozy although whether because of blood loss or impending surgery we’ll never know.

Patrick and James accompany me up the elevator to the third floor, where the OR is. (Um, I think.) It’s pretty quiet up there in the middle of the night, it turns out. The boys would have been allowed to stay with me for a bit longer, but James has called my parents to come pick up Patrick so they head back out to the waiting room. Meanwhile, I get to talk to the anesthesiology student, the nurse anesthetist and the OR nurse. I make conversation, asking if my blood type is still A+ since my mom told me for years I was A-. They probably think I’m stupid but confirm that I’m still A+. (And my mom asks about it later.) Then the anesthesiologist himself comes over and makes me stick out my tongue so he can look at my dental work. Who knew this was such a big deal? The only other thing he asks is how I tolerated anesthesia for my c-section. He would be attractive except he looks like a smarmy dookie. At this point, they start to wheel me back to the OR. “We’re going to OR 9,” says the nurse, “and you probably won’t remember anything after that.” I wonder if it’s going to be cold in there. And then I don’t remember anything after that.

Until James is walking back in and I’m back where we started outside the OR. I’m not in pain, exactly, but it feels RAW and so I get more fentanyl, which doesn’t make it hurt any less but makes my mind wander so I don’t care as much. After a while, I get wheeled to my room, and the OR nurse tells the new nurse that she gave me fentanyl at 4:05, 4:10, 4:15 and 4:25. Interesting. Shortly after getting settled, the nursing assistant comes to take my vital signs. “Every hour for the first four hours,” she chirps, and I remember suddenly why I was so desperate to get out of the hospital after my c-section.

I’m up for good after the 5:40ish vitals check (and James is snoring, loudly), and the nursing shift change occurs around 7. So my new nurse comes to check on me sometime before 8, telling me not to get up to use the bathroom without assistance (which I disregard, later), and I ask her what the timeline is for leaving because I am so ready to be out of there. “You’ll have to wait for your doctor,” she says. “Your hematocrit was 30.” She leaves. I have no idea what this means, and when I grab James’s iPad and google it, it’s inconclusive. But I guess it’s not good.

My mood steadily worsens until Dr. C finally comes back around 11:30. Apparently she was the only OB around, because she’s been to three deliveries, including a c-section, since my surgery. Anyway, she says my hemoglobin levels are the same as they were after surgery – 8.6 – but they haven’t dropped since then, so I’m okay to go. Apparently if they go under 8 you get transfusions. “Like I told your husband, as soon as I got the tissue out, the bleeding basically stopped,” says Dr. C. “So I didn’t have to do any scraping. The chances of any scarring are very small.” She says we have to wait at the very least one cycle before trying again, and she’d prefer we wait two. “Use condoms,” she says as she’s leaving, and the way she says it is enough to give me pause. I mean, I’d wait anyway because I’m afraid to disobey authority and also because obviously I want it to WORK next time so I’ll do whatever gives me the most chance of that happening, but her tone makes me wonder just how bad it was.