The exam room where my husband and I waited for news about our ultrasound was small and dark. It was a routine appointment, 13 weeks, silver shadows on a big screen. We waited for the doctor to come in to tell us about the baby we had just seen for the second time, the round-headed, perfectly formed little thing that was growing inside of me.
The door opened and a doctor we hadn't seen before came in, but that wasn't unusual for this hospital. She had brown hair and brown eyes, which she kept trained on the floor.
She stuck her hand out to my husband Zack. "I am Dr. Minnick," she said. She sat down at the ultrasound machine. When she finally looked at me, I felt like I was going to throw up.
"I couldn't find a heartbeat," she said.
I found out I was pregnant on the morning of my 31st birthday. The pregnancy test was one of a two-pack I had bought during a scare earlier in the year. When, after a forced minute spent rearranging the bathroom cabinets, the second line was hard to see, I frantically googled "faint second line pregnancy test." I found out that no matter how faint the pink line was, its presence indicated elevated levels of human chorionic gonadotropin (HCG). A positive.
I rinsed the stick off, snuck back down the hall into our bedroom, and put the test on my husband's pillow for him to see when he came back from making me breakfast in bed. He walked in with a cup of coffee in one hand and a plate of peanut butter toast in the other. "This is the best toast I've ever made," he said. I stayed silent.
He looked at me, and then the pillow, and did a double take. He set the coffee and toast down on the dresser and grabbed the test. "Is this— are we— does this mean what I think it means?"
None of it felt real. I nodded while we hugged, but I wondered if the test was wrong. We had been married six and a half years, and even though we had been talking about getting pregnant for a while, I wasn't excited — I was terrified. Part of me still felt more like child than parent, made even smaller by this news. My heart knocked around in my chest, and I wondered if Zack could see the anxiety on my face. His joy made me more afraid, and more excited.
The next day, I told my mother and sister that I was pregnant at a café in Elko, Nevada. We were on our way to vacation in Jackson Hole, where Zack and my dad and brother would meet us. I had wanted to wait until we were all together to say anything, but once the three of us were together I knew I couldn't keep the secret for another 24 hours.
"I was thinking next spring we could go to Sedona," my mom said while we browsed our menus. "Maybe fly into Vegas and rent a car, go hiking."
My face changed. "I don't think that's going to work for me,” I said.
My sister Mallory, who had been sitting quietly next to me, roared to life. "You're pregnant!" She yelled with such ferocity that all the diners inside the restaurant turned to us, sitting at a table on the sidewalk outside. I could feel their attention on us as Mallory leaned over to hug me, crying, and I could see our mom steel herself, just in case this wasn't the news, just in case Mallory had jumped the gun.
I pictured the two pink lines I’d seen on the test, and nodded. Recovered, my mom got up to give me a hug and realized everyone in the restaurant was still staring out the window at our small explosion of emotion. "She's pregnant!" Mom yelled, making a belly with her hands and then pointing at me. The two women I love most in the world sat on either side of me, and I couldn't tell their tears from mine as they slid down my cheeks. "We're going to have a baby," Mom whispered.
My mom couldn’t stop herself from sharing the news, so we left a wake of well-wishers in roadside diners from Nevada to Idaho. A waitress who called everyone “sis” asked me if I believed in love at first sight. “Because that’s what it is, sis. You push that sucker out and look it in the eyes and you’re a goner.”
We came home from Jackson Hole to three enormous packages from a friend, presents for the baby that had made our house sitter suspicious. "Is there something you should tell me?" he asked over text, with a picture of a Jumperoo. "Tell him it's for someone else’s baby shower," I said to Zack, but Zack was too excited. His excitement was contagious, and as we slowly started to tell more people about the pregnancy, I found myself less scared.
Nine weeks along, at our first ultrasound, we saw what looked like a silver bean with a fluttering center. "That's the heartbeat," the midwife told us. We took pictures of the screen to text our families, along with bad jokes. "Looks just like Zack!" I wrote to my in-laws. We scheduled our next ultrasound for four weeks out.
"You will be such a good mom," my sister told me, and part of me still couldn't believe this. Moms were supposed to be so many of the things I was not: selfless, calm, wise, mature. Nurturing has never been high up on the list of qualities I possess. What if I failed? What if I wanted to return the baby? The next week I read a book on postpartum depression, just in case.
On a hike on vacation in Santa Barbara, Zack and I asked each other questions. "What about sleep training?" I asked. "Sleep training?" he responded.
"Okay, well, diapers. Cloth or regular?" I asked.
"They make cloth diapers?" he asked, making a face.
We kept hiking until we could see all of Santa Barbara, the town we had met and fallen in love in, and its red roofs and the Pacific Ocean and the Channel Islands, Santa Cruz and San Miguel and the three little dots of Anacapa. The day grew warmer as we walked. "I think regular diapers should be fine," he said. We fell in step, holding hands. We’ll be fine, I thought.
That afternoon I took flowers to a friend who had recently miscarried, at 13 weeks. I held the bouquet over my belly, embarrassed at the thought that this new life in me might be painful for her to see. "I'm so sorry," I said. "It's so common." She looked like the picture of health as she put the flowers in water and thanked me for bringing them over. She didn’t cry, and I didn’t ask many questions. I would have done that differently, knowing what I know now.
The ultrasound was scheduled for 8:30 on the Monday morning after our trip to Santa Barbara. I was 13 weeks and 4 days pregnant, and the app that I checked every day told me, "Your baby is now the size of a jalapeño." Three inches long, with a body that was growing to match the size of its enormous head, with tiny hands and feet.
We checked in at the doctor's office at UCSF. I lay down, and within a minute we were seeing that small silver bean again, but this time it was shaped a little more like a baby. The ultrasound technician took pictures as she ran the wand over my belly. "To show the doctor," she said as she snapped measurements. The measurements seemed small to me, but I didn’t say anything because I wasn’t sure. Zack held my hand as we looked at the tiny thing on the screen.
I worked on convincing myself that everything was just fine as we waited in that dark room. And then the doctor came in and she told us that she couldn’t find a heartbeat.
I leaned all the way back in the exam chair. My face got hot and the backs of my hands were numb. I couldn’t feel my toes or my tongue. I took the tissues the doctor had handed me and started mopping at my face. She couldn't find the heartbeat, okay. Did she need to check again? Could she check again?
Zack's hand reached out for mine and I took it, even though I couldn't bring myself to look at him. The doctor kept talking, but her words didn't register. The screen in front of us still held the image of the baby floating upside down, tiny limb buds protruding from a tiny body. Too small. I hadn't felt much growth the last four weeks. I hadn't noticed my belly getting bigger. How could I have missed it?
"Oh," I said. "How did this happen?"
The doctor looked startled. "The fetus stopped growing at nine weeks," she said. "This happens commonly in the first trimester, usually due to a genetic abnormality that makes the fetus incompatible with life. It was doomed from the start."
"Oh," I said.
"An advice nurse will be in soon to go over your options," the doctor said.
An eternity passed while we waited for the nurse. We couldn't speak for all the time that filled the room, every minute of the pregnancy and every minute that lay ahead without it. Slow, hot tears spilled out of my eyes, and Zack got up to try to turn the lights on. He hit the light switch five, ten, fifteen times, but the darkness remained.
The ultrasound technician brought me a cup of water, and right then I hated her for having known what we didn't know, for knowing while we took pictures of our dead baby on the screen and cooed over its perfect shape. Feeling that way wasn't fair to her. She was only doing her job.
Finally, the nurse came in and hit the light switch. The room felt so small all of a sudden, and I thought that I was going to hyperventilate. That I was going to die. But, at that moment, I didn’t mind dying. She handed me a piece of paper. "I am so sorry for your loss," she said, and I started to sob in earnest.
In delicate script at the top of the paper was written "What are my choices for miscarriage treatment?" It was the first time that day I had seen the word “miscarriage.” There were three options, the nurse and the paper explained: Watch and Wait, Medication, or Suction Procedure.
Miscarriage means to carry badly. "A morbid expulsion of an immature foetus," according to the Comprehensive Medical Dictionary. But the cases where the body hasn't expelled the fetus are called "missed miscarriages." A double miss. You miscarried the baby, but you also missed the miscarriage altogether.
For four full weeks after the baby died, we had gone on telling more and more people that we were pregnant: "I'm pregnant," I told my editor over coffee and pastries one morning. "I'm pregnant," I told my husband's college roommate and his wife. "She can't have any beer; she's pregnant," my husband told a waiter at the Firestone Brewery in San Luis Obispo. It was a twisting sort of irony that in some real way made me a liar.
Although the baby had stopped growing at nine weeks, the nurse explained, the amniotic sac had continued to grow inside of me. I wasn't a candidate for the at-home medication, so I could either wait for my body to naturally expel the fetus or schedule a procedure. But I couldn't wait anymore. The baby had been gone for four weeks and showed no signs of leaving. We scheduled the procedure for Wednesday morning.
The nurse's eyes were full of tears as she put her hand on my shoulder. "I am so, so sorry," she said, and I felt the need to comfort her. "Me, too," I said.
"It's not your fault," she told me, and I thanked her and then I worried, because up until then I hadn't considered that it could be my fault.
"What caused the miscarriage?" the paper the nurse gave me asked. "You did not make it happen," it answered. "A miscarriage is nature's way of ending a pregnancy that would not be healthy." Doomed from the start.
The nurse left, and Zack and I stared mutely at each other. I sat up, now that I could without fear of fainting. I had the feeling that if we stayed in that room it could contain our bad news, so that we wouldn't have to take it out into the world with us and make it real. But there was nothing left for us there, so we left.
As we walked out of the hospital, I tried to arrange my face so that it wouldn't make anyone else sad if they happened to look at me. I frantically wondered how we could turn back time just an hour, just a day, just a month. Surely there was something I could have done to change this ending. In the car, I called my parents. "They couldn't find the heartbeat," I sobbed into the phone while Zack drove. "We're on our way," my mom said. I could hear my dad crying in the background, and my heart broke even further than I knew it could.
There are many administrative tasks to a miscarriage. You have to tell everyone, including your boss and your sister and your husband's parents. We thought we were in the clear at 13 weeks along, so we had already started telling all of our friends and family, some only a few days earlier. We didn't have the energy to make dozens of phone calls, so we sent text messages. I felt an urgent need to update everyone who knew, as if I had passed out bad information and needed to correct it as quickly as possible.
When we had called or texted or emailed all the people we could possibly stand, Zack took my hand and grabbed a red comforter we use for guests and went into our bedroom. We lay under that comforter for an hour and I held him as he sobbed; we could cry together now that we no longer needed to be pillars of strength for each other. It was an animal sadness born of the worst kind of disappointed expectation. The future stretched out before us, one torturous minute at a time. The sadness lived in me as an ache in my stomach, and it’s with me still.
When someone you know and love dies, your life changes, and it is the change that fuels your grief. You can't call them or see them like you used to; you can only smell their cologne on the clothes that still hang in their closet. But when it's a fetus that has died, or a baby, or whatever you want to call it, your life doesn't change, and that's the strange part — because it was supposed to.
Your belly was supposed to grow, but it doesn't. Your breasts were supposed to get more tender, but they return to their normal size. Your office was supposed to be turned into a nursery, and you resented that, but now the plans for a crib and a changing table are gone and nothing at all needs to change. The sadness is in how things stay the same.
Wednesday morning came faster than I wanted. My mom drove us to the Women's Options Center at UCSF, a building with a modern-looking facade and worn linoleum floors and dingy yellow walls. A red-haired nurse with cat-eye eyeliner named Annika came to get me and said, “I’m going to take you into the exam room just the two of us for a moment.” In the gentlest voice I had ever heard, she began to explain the procedure to me while gesturing toward the four prescriptions I had picked up the day before: two antibiotics, an anti-anxiety medication, and a painkiller.
"To start, we'll have you take the misoprostol," she said. Misoprostol, I learned, was originally developed to prevent ulcers by reducing the amount of acid in the stomach, but it also has the effect of causing uterine contractions and softening the cervix. Then it was lorazepam, and ibuprofen, and a battery of antibiotics I couldn’t pronounce.
"You can expect some cramping during the procedure, but it shouldn't be too bad,” Annika explained. “The procedure will last around 15 minutes. You won't be able to hear anything from us while it is happening." I had been worried about that last part, and curious, wondering if the vacuum aspiration would be audible. It was a gift to know it wouldn't be.
Zack and my mom came in, along with Karen, the doctor who would be performing the procedure. She had curly brown hair and an easy presence. She was so competent that I couldn't imagine her sad, but she had been. She told me that she had had two miscarriages, before her two daughters.
The misoprostol kicked in and gave me the worst cramps I'd ever had. I crouched on my chair like a bird on a branch. I took the lorazepam and the ibuprofen and started cracking jokes. I joked about watching the movie Deliverance, which Annika thought was hilarious. I thought, Do I feel sad? I did, but I also felt loopy, and numb.
When I lay down on the table to start the procedure, I joked about taking the fetus home and stuffing it like a taxidermied fox. No one laughed. It would be so cute, I said, trying to backtrack. When Karen rubbed lidocaine on my cervix, I could feel my lips tingle. After three minutes, the whole thing was over. I waited, I bled, I thanked Karen and Annika. I went home.
That night, I dreamed that I had left the baby in my closet. The baby was a small black-and-white ultrasound printout that I had left on a pile of dirty sheets. I picked it up and placed it back inside of me, and everything was fine. In my dream I also went for a long walk to Bernal Hill, which looks out over all of San Francisco. All of a sudden my whole body was too light, and I floated above San Francisco until I ended up back in the exam room at the Women's Options Center, bleeding all over the linoleum floor.
There is a Japanese word, mizuko, which literally translated means "water child," but is used to refer to a child who was never born, whether through miscarriage, abortion, or stillbirth. This was a life that never made it out of the waters of gestation.
One of the most vexing parts of a miscarriage is the linguistics. What was lost? A baby? It feels odd to use the same term for a healthy child, but also honest, when I consider how real this being was to me. A fetus? That feels clinical and conciliatory. At times it is necessary to talk about "the tissue" or "the pregnancy," but I could never say that this pregnancy was only tissue to me. We had a nickname for the baby; it started with a P. P made me so sick, and so proud. And now I am so, so sad.
One of the most common refrains you encounter when you have a miscarriage is that “nobody talks about it.” This is both true and not true. Talking about miscarriage is complex and personal, and no one who doesn’t want to talk about it should have to. But I had several people to call as soon as I got home from the hospital, because close friends of mine had been open with me about their own miscarriages.
My friend Micha came over a few nights later with a bottle of rosé and some ice cream and we cried as I recounted those first minutes and hours without that second heartbeat in my body. She had gotten her own news at her eight-week ultrasound that there was no heartbeat. She bled for days after the D&C, in and out of sleep on the couch watching Austenland while her two boys played around her. Women like Micha came out of the woodwork once I started to share my news: Jessica, 10 weeks. Emily, 9 weeks. Heidi, 15 weeks. Alicia, 8 weeks and 6 weeks. It turns out women were always talking about it. It’s just that most people weren’t listening.
For weeks after the miscarriage I felt like a madwoman, digging for stories everywhere I could. I emailed old acquaintances who had miscarried and asked if they wouldn’t mind telling me everything that had happened. I stayed up late googling “miscarriage stories” and nearly walked into traffic holding books with titles like Empty Cradle, Full Heart.
“Even if you are not Robinson Crusoe in a solitary fort, as a human being you walk this world by yourself,” Ariel Levy wrote in her essay about miscarrying at five months while in Mongolia. “But when you are pregnant you are never alone.” For three months I was never alone, and then, all of a sudden, I was. I wanted to be not-alone again. I wanted stories that shared my grief.
In the literature of miscarriage there are two distinct genres: online forums where women share urgent updates and well-written stories from those who have some distance from the event. There isn’t much in between, which is where I stand. My miscarriage happened sometime in mid-July. I learned about it on August 15. This is fresh news, and I am still grieving. And I am not pregnant again.
My grief is as near to me as the ginger lozenge on my nightstand, a remnant of the pack I kept at hand to ward off morning sickness. In our refrigerator door there is a row of red Gatorades, one of the only things I could consume when I was sick. The parenting books I bought are in a pile underneath my side of the bed. We had been keeping a bag of gifts in the front bedroom, the room that would become the nursery. Now the gifts — a soft gray blanket; blue moccasins; three cardboard books, including Pajama Time and Little Blue Truck; a soft white onesie with a sun-and-moon print — sit in our storage unit downstairs.
In the last ultrasound, you can see P floating upside down in my uterus. The baby looks beautiful, like an outline of a Kewpie doll I had somehow swallowed. We thought, for a few minutes, that this was our entire future in one picture.