I had been looking forward to our 18-week anatomy ultrasound for over a month. As a home-birthing hippie who had a midwife and barely any medical intervention at all while pregnant with our three daughters, I was relishing the experience of bonding with this one -- my fourth and final pregnancy at age 41 -- by seeing its mysterious little silhouette on-screen.
"Will it be a boy or a girl, Mommy?" my 6-year-old asked as I sent her and her sisters off to school.
"You'll know when you get home from school today!" I said.
My husband and I joked easily in the waiting room of the high-risk maternity center (where I had automatically been placed because of my age), though couples around us sat in grim silence. We became slightly less relaxed as the minutes crept by. I had screwed up my appointment time (my special talent), and my husband became annoyed by the waiting. I had anticipated this moment with the intensity of a child counting down the days till Christmas, but it was not quite turning out as expected. By the time we were finally ushered into the ultrasound room my husband and I were engaged in a sotto voce round of bickering -- can't believe you messed up the time/stop ruining this for me -- only to be struck silent by the magical appearance of our baby on the screen.
It was another girl. Another girl, even though I'd secretly hoped for a boy, even though everyone felt compelled to tell me they " felt" it was a boy. I tried to squelch my unreasonable disappointment by concentrating on my daughter as she appeared to me: adorable little hands and feet, a flash of a formative face. But the ultrasound technician wouldn't stop talking.
"Come back here, you little bugger," she said, increasing my niggling sense of unease. "Wow, this baby's an uncooperative one."
It wasn't until she finally left to get the doctor that my husband and I began to relax. We wondered which of our beautiful girls this one would resemble: tall and composed Lailah, with her mysterious almond eyes? Free-spirited Lucero, with her wild mane and mischievous grin? Petite Annike, with her delicate features and blond hair? Then the doctor entered.
"We have a problem," he said. And our nightmare had begun.
He took over the controls of the ultrasound machine, and I began to sob uncontrollably as he guided us through what was wrong with our baby. Apparently the heart that had just moments before filled the room with its percussion was seriously undeveloped on the left side. There was a significant lesion in the brain, and he couldn't find evidence of a pinky finger. Because of his gentle and professional manner -- somewhere between a Methodist minister and a bank president -- it took a while for us to absorb the full magnitude of what he was trying to tell us. It was like a complex yet impatient territorial negotiation between two distantly related tribes:
Husband: So, this heart defect means the baby will need an operation when she's born?
Doctor: Actually, this is more serious than that. There's almost no blood being circulated through the left chamber of the heart here, and I see no sign of the major artery that connects ...
Me: The aorta? You don't see the aorta?
Me: Could it be it's just not developed yet?
Doctor: Actually, no. It should be in place by now.
Husband: And the lesion in the brain?
Doctor: Sometimes they don't mean anything. But with the serious heart defect, plus the digital deformities, it might be a sign of a chromosome disorder.
Me: But I tested negative for those!
Doctor: Actually, those tests can't rule out disorders like trisomy 18, they can only predict your probability ... we're going to have to perform amniocentesis to be sure.
Me: Right now?
Later, back in the doctor's office, I discarded my Ph.D. and my dignity with the fusillade of sodden tissues that did not all make it into the trash can near my feet. I simply hung my head and cried like a child while the doctor patiently outlined the details of the problem to my husband, pointing to the printout of our baby's undeveloped heart and using grown-up terms like "hypoplastic left heart syndrome," "trisomy 18," "heart transplant" and "unsurvivable." Trying one last time to make sense of the incomprehensible, I raised my head to look into the doctor's kind, yet slightly vacant blue eyes.
"So this is bad?"
"This isn't just kind of bad," he replied with a paternal finality. "This is really, really bad."
I could not believe it was happening. Those five liters of blood I gave up two months ago were supposed to have insured me against all types of first trimester boogeymen! Shouldn't I also have some kind of better-luck credit for bravely trying again after last winter's miscarriage -- when I had made it all the way through the grueling, soul-crushing nausea of the first trimester, all the way through the discretion of "don't tell anyone until you pass week 12," the exact day upon which I began the bleeding that marked the end of that pregnancy? Was I, after all, just another sorry Icarus, punished for foolishly flying too close to the sun to risk one more middle-aged shot at maternal glory? How could this vigorous baby whose movements had been delighting me since week 12 be so heinously compromised that she bore a better chance of being stillborn than surviving more than 24 hours outside of my womb?
But it was happening. And as is generally the case with nightmares, it simply got worse. The amniocentesis results came back conclusive for trisomy 18. The children were devastated. I had to go to a doctor with whom I'd previously had a bad experience -- the only OB in the area qualified to do late-term terminations, apparently -- and repeatedly paid my absurdly high copay to have seaweed inserted into my cervix, then return starving and dehydrated the next day (no food or drink after midnight, five-months-pregnant lady!) to be further dilated, before rushing off to the hospital to be promptly mishandled, ignored and given insufficient pain medication as I labored in mental and physical anguish for the interminable hours leading up to the medical termination of what would have been our very much loved, and much wanted, fourth daughter.
Recovery has been rough. Three unwashed weeks of lying in bed; months without food, without appetite; heroic acts of love from my family and friends. Then, there were the whispered confessions of friends and acquaintances -- "This happened to my sister." "This happened to my friend" -- that made me realize how common our experience actually is. It finally helped me to understand this isn't a crushing blow the universe directed against me, personally. This is just something that happens, the brutal reality we hope we can inoculate ourselves from in the 21st century with our doctors, our high-speed Internet and our perfectly planned nuclear families.
"Are you going to try again?" people ask all the time, and it seems like each person already has an answer in mind. They are thinking this was a sign I should give up and slide into middle age gracefully. Or they are thinking that our family deserves another baby, that the worst is behind us now, that trying IVF and other therapies could give us hope.
But I don't have an answer yet. Right now I am simply trying to take care of my own heart, and my husband's, both of which suffered an irreparable fissure the moment we learned about our baby's compromised one.