DVT Update and I Hate Being Sick

This morning I had my first appointment with a Maternal-Fetal Medicine doctor who specializes in blood clots. I actually set up this meeting precisely one week after my transfer - three days before my first beta hCG test would ordinarily have been done - and I kind of wonder if that's some sort of record. Congratulations, you have literally only been pregnant for a week, and it's off to the high-risk doctor!

There was good news and bad news from the appointment. The good news is that he was really optimistic about my pregnancy in general, despite being surprised that I hadn't yet gotten an ultrasound to confirm. (Ummm... it's on Friday?) He said that my beta hCG values had doubled right on track for a singleton pregnancy and my fatigue and nausea were signs that everything was proceeding normally. He also said that my thrombophilia bloodwork had come back showing NO genetic mutations and that all my levels were within normal ranges, so it appears that I don't have any inherent predisposition towards clots. Great!

The bad news, and I think he didn't really consider it bad news but I sure did, is that if he had to guess right now then he would expect that I will have to stay on the Lovenox right through the pregnancy and six weeks after the birth. He mentioned that at 35 weeks or so, I'll probably switch to Heparin so they have more options (epidural, C-section) during labor and delivery. If I need emergency surgery at some other point during the pregnancy, that could get interesting because it takes ~24 hours to get Lovenox out of your system, though of course it's low odds that something like that would happen and they would weigh the benefits and risks at that point. Additionally, they don't like to see ladies with clotting problems go past dates, so he said that there's a chance I would be induced between 38-39 weeks... I have two responses to that: 1.) I wake up every day thinking that I've miscarried, so let's just hold off on all the labor and delivery plans for the moment, mmkay? and 2.) I'm not inducing. I mean, never say never, but induction to me is a last-ditch, everybody-is-about-to-die, this-is-an-indication-of-huge-problems kind of option. My experience with the world of obstetric and gynecological medicine to date has pretty neatly illustrated the problem that one intervention leads to another problem which leads to another intervention and so on. The link between induction of labor and increased complications (including a higher C-section rate) is pretty well established, but this is a battle that I'm just going to wait to fight on another day.

All of this is essentially fine, although I'll feel like less of a fraud when someone confirms using ultrasound that there really is a tiny human living in my belly. So why did I burst into tears in the parking lot after the appointment? Here's the problem. If I think about the baby, I am flooded with gratitude and humility. But then I think about what my husband and I had to do to get here and the rage that simmered in me throughout the past few months - with occasional, and notable, moments of boiling over - just comes back full-force. The news that I'll probably be on the Lovenox until 6 weeks after delivery (for those of you keeping score at home, that's nearly a full year of painful, bruising, daily self-injections) was really upsetting to hear. My Lovenox bruises are a visible sign that something is not right with me. It doesn't take a genius to read what I've written to date and realize that the most traumatic parts of this experience were when I was most actively being treated for my infertility - the initial surgery on my ovaries, the start of injecting myself with leuprolide acetate, my egg retrieval procedure, my DVT diagnosis, the constant blood draws to check my hCG level. Now I have a messed-up pregnancy, too. I am deeply bothered by the idea of illness and being an ill person, and a lot of this probably stems from the experience my family went through recently with my mother's cancer treatment, but I'd venture to say that it's also pretty common. A lot of the literature on chronic and terminal illness mentions this feeling among patients, and the most vivid description I can find is what Susan Sontag writes in Illness as Metaphor:

Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. Read more here.


So every night, when I inject the Lovenox, I feel like I'm being kicked right back into the kingdom of the sick just when I was starting to think I might be able to live back in the kingdom of the well for a while. I start thinking about how I'm never going to be able to show off a baby belly and I'm probably going to have to do this right through New Year's Eve for 2013 and, you know, I still really want to tell my RE how much I hated my egg retrieval procedure (I'm concerned that now that I'm pregnant, all of our interactions are going to focus on my pregnancy and I'm never going to have a chance to tell him what my experience was like and how, frankly, I was right to worry and feel that I was justified in freaking out on him ahead of time.) I had hoped to move on from all of this unpleasantness, but no, it's still going on. And realistically, it may never stop - welcome to the world of chronic illness.


Still, eye on the prize, right? I like to sign off on a positive note, so I will say again how grateful I feel to be pregnant right now. I have felt a frisson of excitement for the future here and there - during the worst moments of morning sickness I've even started distracting myself by bookmarking cute maternity clothes online, but that's a story for another time. Keep your fingers crossed for a good report on Friday!