9 weeks and 2 days

I'm still processing so this may not be pretty.  Trigger warnings this talks about loss and body issues.

I've been exhausted for weeks.  I had a weekend hospital shift (which are notoriously hard). I was coming down the the virus that everyone else in the household had.  Everyone knew these facts.  What everyone did not know was that I was about 9 weeks pregnant.

My husband and I had made a clear decision to tell as few as possible in the first trimester.  I took Reproductive Epidemiology in public health school.  I knew that about 1/3rd of all pregnancies end in miscarriage especially in the first trimester.  Also I just didn't want the questions and the looks.  I honestly intended on not telling anyone I was pregnant until they asked and then make them feel guilty for calling me fat.

I expected things to go terribly as my baseline anxiety kicked in.  I literally know everything that can go wrong.  However after a "normal 6 week US" and 8 week first prenatal.  I was cautiously getting comfortable with just making it through the first trimester.  Which is what people kept telling me that was all I had to do. 

Easier said than done with the bone deep fatigue, growing out of all reasonable bra sizes (34 G+ are hard to find), and my baseline duties as a new doc in a resource poor area.  I felt terrible canceling morning or evening clinics when I just could not do another thing other than fall into my bed.  I also have PCOS (Polycystic Ovarian Syndrome) and Insulin Resistance which makes eating more more than 1200-1700 calories against what I've practiced for the last decade.

But as the weeks racked up I was cautiously hopeful that I could make it one more month. 

So I did the right thing.  I called in back up for my hospital shift, which was amazing. I saw patients. I admitted patients.   I did a little clean up work from the previous hospitalist.  I got home about at about 12:30 intending on sleeping for 7-8 hrs before doing it all again.   Then right before I went to bed I went to the bathroom for the last time and saw bright red blood.

This led me to handing over my shift to my amazing medical director (one of 2 people at work who knew).  And heading to the ER at 1am. 8 hours some blood tests and the most uncomfortable ultrasound I've ever had later the verdict was in.  Where there were heart tones before, there were none now.  I got my meds for a missed/incomplete abortion (medical language for miscarriage) went home.  On the way I texted the 6 people who knew who responded with great outpourings of love and care.

It is impossible not to think about the what ifs and possible signs, even though I know the most likely cause is chromosomal abnormality.  At my dating ultrasound I was dating 4 days early was that a sign?  I had a terrible allergic reaction to the sheets at the ultrasound place was that a sign, or a cause?  I knew I was working too hard was that a cause? At my first prenatal 5 days ago she said my uterus was enlarged, should I have pressed to make sure she thought it was 9 week size?   What earlier sign could there have been to tell me that things were not going well?  What could I have done to change this situation?

It's strange to hope for cramping and bleeding just so this part completes itself.   It's strange to still have symptoms of first trimester even though I know I'm not now.  This directly plays in to my appreciation/distaste for my body (love/hate is not quite accurate).  Of course my body which can't process sugar,  lose weight, and makes unnecessary cysts would fail in these ways:  both in staying pregnant and not allowing it to end when it should. 

I'm hoping the meds did their job and this doesn't linger on.  In someways the physical pain is appropriate to the emotional pain.

I find it hard to give myself permission to feel during this.  As a doctor I'm so used to putting everyone's needs before my own, and yet I'm finding it very hard to care about (or even check) my inbox.  While I know that's probably appropriate, I still feel guilty.  I'm also not dealing well with the other pregnant people around me.  Yep,  I'm I little bitter and jealous at this time.

Part of me wants to hurry up and get this over with so I can move on to the next month. In theory my chances are higher the cycle after a miscarriage, but as I said previously my eggs are old.  So should I just go to reproductive endocrine? I only have about 1 year left of my trying (see TTC), so time is running out.

So why write about this?  I was talking to one of the 6 people, another family medicine doc, who knew who noted that people don't talk about this much even though we know from medicine it is so common.  Why don't we talk about it?  Because it's one of the sad realities of life, maybe.  Is because it feels like failing and people don't like to talk about their failures?  Is it because though I've lost so many people in my life (my Father and Aunt Rose most recently) the loss of potential relationship is harder? I don't know.  But I am writing to process, tell my story, and maybe help someone else feel not so alone.

There are no words for the difficulty of this experience.