About One DNP

I earned my "terminal practice" degree in nursing from the University of Tennessee Health Sciences Center in a journey of excitement and challenge. It inspired me to advocate for an all encompassing clinical credential rather than continuing the hodgepodge of nonsensical initials. I hope these entries will provide entertainment and insight into the Doctor of Nursing Practice experience, which will soon be the entry standard for all advanced practice nurses.

Sunday, October 10, 2010

Life in the Midst of Midterms

And finals.

I posted most of the following on another blog, but feel it is important to include since this led to asking for extensions on all of my tests and assignments this past week. I have never done this before, but I realized there are some things you can't just suck up and perform. At least if you want to stay sane. Since I am specializing in mental health, I decided to practice what I preach and ask for help. Thankfully, all of my professors gave me an extension without asking for an explanation. And here it is.


We found out we were pregnant in August after 8 positive home pregnancy tests.
Since I had a miscarriage in June, I wanted to get serial HCGs and breathed a sigh of relief when it doubled in 48 hours and my progesterone was where it needed to be. Went for the ultrasound on Sept 22nd with hubs laden with camera gear. We should have been about 9 weeks along but the fetal pole measured 6 weeks 4 days. I can read ultrasounds and I saw there was no heartbeat. Doc told me to come back in a week to make sure because I could have been off on the due date.

Surprisingly, this was not the longest week of my life because by the time we walked out of the office, I came to grips with the fact he (I always felt the baby was a boy) was dead.

Sure, there was a chance, but somehow I knew we would not be in the lucky percent. I had a dream a couple of weeks ago that I gave birth to a belly full of water. I also had stabbing pains in He-Gu, an acupuncture point that is contraindicated in pregnancy because it can dilate the cervix. Around week 7 I also developed a total aversion to all the prenatal books and videos I had been so gung-ho about and had stopped browsing Amazon day and night. None of this was meaningful at the time, but as I sit here and think, they all kind of work together.

I am a little irritated that the first pregnancy symptom to go away was the great complexion I had developed.

I spotted very lightly through the week, so I had prepared myself for the inevitable. On the return trip to the OB, the fetal pole measured 6 weeks and 1 day but the gestational sac had grown. Great. Before he could finish the "D&C" talk, I asked how he felt about 800mg of Cytotec i-vag instead. He was somewhat surprised (hell, if you told me a few years ago I would rather pass a dead baby then get it all over with at once with a D&C I would have called you crazy) but he did a quick consult with one of his partners and fixed me up with 2 prescriptions and his cell phone number.

A part of me was hoping I would not need it, but by Friday night I was still spotting only slightly heavier so I decided to take the plunge around 8:30. I also popped 5 mg of valium hoping to sleep through the cramps. I didn't, but I also don't remember them that well. Even knowing there is no life to be had, it was still difficult to do this. Had I though there was even a slight chance I would have waited another week, but unfortunately clinical reality squashed optimistic hope.

Within a few hours, I had mild but escalating cramping. I spend a good part of the wee hours of the morning writhing around and deep breathing. I guess the "Bellydance for Labor" video paid off since the more I moved my hips, the less it hurt. And it hurt.

24-hours later I am not gushing as some others have described, and while I have clots I have not passed the sac. I don't think this is going to be real for me until I do.

I had a deeper attachment to the baby this time than I did the first time, yet somehow this miscarriage is easier. I guess it is a combination of saying good-bye, not having told as many people, and navigating (unfortunately) familiar territory. The good news is, we are fertile and, with hope, will remain so and actually conceive and carry next time.

I have to admit I harbor some bitterness over the situation since, as a nurse practitioner and psych nurse, I have seen so many women do everything wrong and have one baby after another without a problem. On the other hand, I have several clients who have due dates close to when I should have been due for both my first and current miscarriage and I feel so happy for them and proud of the role I played in helping them conceive.

As for trying again, I do not think I am going to be ready for quite some time. I am not sure I can ever have a positive pregnancy test again and feel excited about it. It sounds morbid, but I feel as though "hey, we made it over halfway through the first trimester this time, maybe we will get all the way to the second trimester before we kill the next one." Maybe I need to take up smoking or a crack habit - it seems to work well for a lot of my former patient population.

Hmmmm, that was not a subtle defense mechanism, was it?

As the guilt wheels start turning, I wonder if I did too much baby acknowledgement and prenatal madness. Too much reading, too much talking to the baby, too many prenatal workouts. But then again, I do not want to second guess my actions since all of the research left me armed with a plan for the future - doulas, hospital, postpartum care, etc - so it was worthwhile for next time. Or maybe someone else's next time.

There is plenty of info on the feelings and emotions related to miscarriage, and I have been through all of them. Since I had a difficult time finding personal stories, I wanted to speak to the physical aspects of what happened to me on the end of my Cytotec journey.

At one day past the Cytotec dosage, I was toeing the line between heavy spotting and light period with discomfort, but not pain exactly. I planned on giving myself until Monday evening to start the second dose if things had not progressed.

Monday morning I want into the office around 9 for my first patient and the cramps, well, I think I should call them contractions since it felt like a vampire squeezing my uterus, began. I popped some IBU and arnica which did little to help anything. By 10:30 I had passed 3 baseball-sized blood clots that were, thankfully, bright red. Not really knowing what the sac was supposed to look like, I collected one of the clots thinking there might be tissue in there.

I clinically detached first because, aside from the entire thing being tragic, it is an amazing process. The sensations are unique because they are cramps, but they are much different than your basic menstrual variety, and the passage of the endometrium is morbidly fascinating in an "did that just seriously come out of me" way. Second, I needed to dissociate for my own emotional stability.

About halfway through my next patient I was doubled over in pain in the office bathroom and begging for 5 minutes of peace so I could finish up and cancel out for the rest of the day. I have never had malaria, but I must of looked like I did with the cold sweat that kept dripping off my forehead. The "Bellydance for Labor" video was worth it's weight in gold because it really did help move through the contractions and decrease the pain.

At noon (about 5 minutes after my patient left), the pain reached epic proportions and shortly after, baby and all came out. There is no mistaking the difference. The sac looks like a little wrinkled balloon attached to the dark tissue of the placenta. After delivering (I guess you call it that), there were no clots and the pain backed off considerably, but did not totally abate. I have worked-out nearly every muscle in my body before, but this was defiantly new territory for DOMS.

Fred has been a rock, but when I handed him the bag to put in the fridge before going to the OB, he broke a little. After the pain settle down a little, we went over to the OB and he told us it looked like I had passed everything. I wanted to open the sac and see the baby, but I knew they wanted to run tests on it so I left well enough alone. I did take a couple of pictures though. He expects I will continue to have a light period for a week or so, and then have a normal cycle in 6-8 weeks. After that, he is going to run a bunch of tests to make sure all of this is not the result of a clotting disorder.

I cannot say Cytotec was the reason for this occurring Monday or at all, but what I do know is I do not require a D&C, which was my goal. I did not have the massive bleeding others have described, but there was still quite a bit. I hope I never have to go through this again, but if there is a next time, I am going to be sure to ask for some hydrocodone and take a few days off.

Today the clinical observation persona has given way to wistful-mommy-not-to-be grief. I am grateful I have a support system to rely on and that I now have an idea of what labor will be like (to a very small extent) when I finally do have a term pregnancy. There has been a lot of outside drama the past couple of days which I feel is a great distractor, but I am going to have to process this soon if I want to move on.

I made an over-ambitious workout plan for this week, that I quickly realized needed adjustment. I gained back 7 pounds of what I had lost so I am ready to get back on the weight-loss plan next week. In the meantime, I am trying not to "feed the soul hole" with comfort foods, and getting 30 minutes of cardio or weights in every day.


Okay, the grief-bravado lasted a day and the mourning hit hard and fast. All of the pregnancy symptoms disappeared and I was left with continual cramping and aches until last night. Thursday night I realized I was going to fail the Epidemiology final and Stats midterm if I did not ask for an extension, and there was no way I was going to have an effective empathy recording for Interviewing and Counseling because I had none. I am granted an extension until Wednesday and decide to take the weekend to really process and take all of the support my husband had to give.

We had a wedding to go to this weekend and mingled with a lot of folks we had not seen in over a year. I was hoping I could be bride-centric, but naturally we were asked about our plans for children. Fred and I are terrible social liars, especially with friends, so we wound up telling a few people what happened. We received an amazing amount of support and hope. I have found even unhelpful comments usually are a result of wanting to say something and are meant to show concern, so I appreciate them.

I am thinking about re-labeling my prenatal vitamins "pre-conception" so it does not feel so depressing. I am taking a postnatal herbal formula that has also helped with the emotional ebb and flow as well as the dizziness and aches. I packed up all of the books, DVDs, and other accouterments I acquired to celebrate the pregnancy. Fred finally looked at the pictures I took and it made me feel so much better emotionally and physically to share that. He has been amazing through this entire experience and has postponed his own processing to be strong for me. I hope to be as strong for him when he finally lets himself grieve.

Right now the nights are the worst. It is when I feel the intensity of the loss. That was my baby meditation time and when I felt the most excited and pregnant.

There was discussion in class about the benefits of therapy as a healthcare provider and I thought at the time a mental health check-up was a great idea for everyone. we are looking into a few options to help get through this time, but I imagine I will need some sort of support for the next pregnancy as well.

1 comment:

  1. wow, jaclyn. i totally understand.

    i'm so sorry to hear about all of this and hope that you are healing ... in every sense of the word.

    just understand that everything you are feeling (and not feeling) is completely normal. i didn't think i would ever be happy to see a positive pregnancy test again ... and i wasn't. when i took the first test with harper, i burst into hysterical and terrified tears. and for the rest of that crazy, scary, completely abnormal pregnancy, the fear only subsided a little bit. i just felt betrayed by my body. i didn't feel like i could trust it to do its job, even as, like you said, women that have no business having a baby do it all the time. and i felt guilty about it. it's all just ... hard. pregnancy is hard. babies are a miracle. the people that think otherwise or have conceptions or pregnancies that indicate otherwise are LUCKY, not normal.

    let me know if you need anything. when i miscarried, and when i was quite sure that we were losing harper, talking to women that had been through it was, strangely, a great comfort. i don't know why it made things better, but it did.

    lots of love and healing thoughts from all of us!