writing and crying

You can't write and cry at the same time.   I wrote that sentence, or something like it, back when I first started blogging.  I think it was part of a post trying to justify -- to myself and to the world at large -- my inability to see anything larger than my own anguish, the posts choked out of me like sobs.   

I say "or something like it," because I can't be sure exactly what it was that I wrote.  Though I try to be reasonably scrupulous about checking those things I can check, I can't bear to go back and read through my early posts.  Even imagining them triggers a shuddering claustrophia, terror of going back to that dark and narrow place.   

I feel a little of the same fear when I read blogs written by the newly bereaved.  I'm less wary of those who, like me, started blogging only after their losses as a way of channeling their grief.  On those blogs, the words tend to be weighed and filtered, the pain veneered with prose.

More difficult to read are the blogs by people who've been chronicling a pregnancy, when suddenly everything goes terribly, unexpectedly wrong.  I start those stories at the end, then go back to read the earlier posts, viciously ironic in retrospect: the heartrate at the first ultrasound, a link to the options for changing tables.  

I read those older posts like a novel, seaching for clues that might foreshadow the coming disaster.  But, of course, real life doesn't work that way.  We're always being blindsided.  We're always unprepared.  Life is a run of discontinuities and the gods have a weakness for the O.Henry ending.   

When I come to the end of the posts, I feel helpless.  I want to give something, but when I look down I usually find that my hands are empty.  My experience -- however similar to theirs -- is valuable mostly to me.  All I can do is watch and, once in a while, say something that I hope is, if not exactly right, at least not too blatently wrong.  Because if it's hard to write and cry simultaneously, to read and cry at the same time turns out to be no trouble at all.

Do you read lostbaby blogs?  Do you comment on them?  Are there specific things you try to say or not to say?

the silent refrain

silent: said, or screamed, yelled, whispered, in the head. Not said aloud via the lips.

refrain: recurring word, phrase or sentence. perhaps a sound.

the silent refrain: a word, phrase or sentence that you keep saying, yelling, whispering, or screaming, in your head. a sound that keeps going on in your head.

::::::::

Twenty years ago: I was a good student. Trying hard to keep up with the grades. Polite and toed the line.

My silent refrains then:

"Blah, blah, blah... ... can't you adults say something else?"

"Why do grades matter so much?"

"I am scared to shit. What if I forget the answers?"

"I need to get out of this place."

"Nobody understands."

"Life sucks."

"I wish my boobs can be a bit bigger."

"How come they just don't get it?"

"I want OUT of this system."

:::::::::::::::::

In the last eleven months, my silent refrains have been:

"WHY?!"

"Did I really deserve that?"

"I cannot take this pain any longer."

"My baby died, you idiot." (Usually when asked at the stores "How are you today?")

"Don't you dare ask where my baby is."

"Don't you dare look at my big, floppy belly."

"You just don't understand, you are such an ASS."

"My baby died, you moron."

"Wipe that stupid smile off your face. You won't smile at me like that if you know my baby died."

"Just let me die."

"Stop smearing your happy shit over my face."

"My baby died. Can you shut up please?"

(when looking at my two girls): "Love them now... love them now... you don't have all the time in the world..."

Often, this comes up when I am standing in the shower, I dunno why:

"No, he did not die. Of course not. Are you crazy?"

Some are not as violent or rude as those listed a little above, but still cuts deep:

"Where are you, my son?"

"Please talk to me, Ferdinand."

"Can you tell me if you suffered? Did you feel pain?"

"Am I unworthy?"

"Do you know this pain is overflowing?"

"We are all thinking of you today, **** that you did not make it, ****."

"Will I ever get over this?"

"Where do I buy a ticket to the "other side"?"

And on very rare occasions:

"I know I can get through this. I will rise from the cold ashes. I can do it, damn!"

::::::

A lot of the times, just some gibberish yelling in my head, so I do not think hurtful thoughts, suicidal thoughts, or don't-get-me-nowhere thoughts. Sometimes I get more gentle thoughts in my head. Really, sometimes they are even beautiful. But those do not happen frequently.

What is frequent: hearing this sound in my head, which is my heart cracking and shattering, all over again. I also now understand what is a silent scream in the head.

:::::::

Your turn now, what's your silent refrain?

Layers

I don't remember what I was wearing that day. I remember my long black winter coat because before I left I asked Monkey for a hug. But I don't remember what I was wearing under it, what I must've seen all day as I caught sight of myself-- my sleeves as I typed, my pants as I sat down, my belly as I balanced the laptop on my lap while I waited for Monkey at gymnastics that afternoon or as I waited for the kicks that never came that night. I remember the dinner I ate as I tried to coax those kicks, but I don't remember what the shirt was that covered the belly on which I balanced the plate. I remember that the radio was on as I drove to the hospital, and I remember that I thought the program was interesting, but I can no longer remember what it was about. Now that I know that the full moon was in fact supposed to be there, I can verify that the memory that started knocking on my brain's door recently, of the full disc as I drove, wasn't a figment of my imaginataion fabricated later on-- I really did see it. But I don't remember what I was wearing. Not as far as anyone else could see, at least.

I remember what I was wearing under my shirt. A bellybra, that wonderful contraption that distributes the weight of the belly over the whole back, making it much easier to function. Even if I didn't rememeber, this detail I could reconstruct, as I never went a day without it the last couple of months of A's pregnancy. But I do actually rememeber. I remember because the nurse asked me about it as she was preparing the probe to look for the heart beat. I gave her a glowing review, and she said she needs to remember it for next time because her back was killing her the last couple of months with her first-- what with being on her feet all day. I wonder, given what happened in the next 5 minutes, does she remember it now?

When I first discovered that I couldn't remember what I was wearing I thought of it as a good thing-- next time around, I reasoned, I wouldn't have bad associations with any of my maternity clothes, I could wear all of them again. Except for that bellybra, of course.

I am 28 weeks 4 days along today. If you come to my house, I doubt you can miss the belly. And yet, when I am out and about, I still wear a shawl. Unless it's over 90 degrees outside, and then I put on this net-like thing that goes over my head, is long, and a bit shiny, but is far less of a  disguise, though it still makes me feel a little covered, a little protected.  I waddle, by the way. Thanks to the pelvic pain that makes it hard to walk straight. So I waddle, and the belly sticks out farther then the boobs, and has for a couple of weeks now. And still I insist on having something that gives me some illusion of maybe fooling someone out there.

At first I thought that the shawls were my protection against the stupid that is out there, against the untouched who think a pregnant belly equals a live healthy baby 40-X  weeks from now. I didn't want to talk to them. I didn't want to deal with their "congratulations" and their "is this your first?"s. I didn't want to give them an opportunity to tell me all about their utterly normal life where assumptions of invincibility hold. A bit later I understood that I was also avoiding having to tell people that I am not jumpy and comfy because the baby before this one died. I didn't want to have to tell the story, anew.

It's a weird thing, really. I want people to know about A. How few people know that he existed used to be one of the biggest crazy-makers in my head. It's better now, the crazy is, but this particular thought is still sad to me. It seems, though, that I need to control the context in which I want people to learn. I don't know that it is even possible, but I seem to want to introduce him in some way that isn't all about pain. I want people to see that the pain is there because of how much we love him, how much we wanted him, how much we miss him now.

I remember, so very vividly, being pregnant with A, out and about with Monkey, and conscious of how lucky we were and of how much our luck can hurt to look at. I was thinking of infertiles at the time, but boy can a sight like this hurt a dead baby mama's heart.  I remember, too, last spring seeing pregnant bellies and babies wherever I turned my head. A veritable sea of happy that had no room for me. I started coping by making up sad stories for these happy people I saw on the street-- this one had five miscarriages before this baby, that one needed an IVF or three. I knew, even as I was making up these stories that they can't all be true. But that was what I needed to do to be able to navigate the world around me.

Recently some of the dead baby bloggers have been confessing to having a hard time with other people's pregnancies.  Is it any wonder? And what I realized, reading these bloggers, is that my shawls are a little about all of you too. If I can help it, if I can help it at all, I don't want to add to your hurt. I don't want to, as Bon so aptly put it, stab you with my roundness.

My sister is getting married this weekend. My parents arrived a few days ago and other family is about to descend on us in mere hours. To some degree, I have been measuring this pregnancy in intervals of and between significant events. For the last few weeks I have been terrified that this baby would die before the wedding, adding new layers of terrible to what would be horrific any day all on its own.  Before that I was similarly scared he would not make it through the week Monkey and JD spent in the Old City. 

That Monday, Memorial Day in fact, I wan't feeling as much movement as I had been used to. I tried the water, and the couch, I tried this, that, and the other. And finally I couldn't handle it anymore, and I went in to triage. A friend of mine is a high risk OB in my practice, although he didn't start there until last summer. When I first heard that he was joining the practice, I thought I didn't want him to ever have anything to do with my care-- I didn't want him to have to feel bad if shit hit the fan again. But as I pressed the intercom button outside of triage that Monday, I saw my friend walking down the corridor. And suddenly I very much wanted him to be there. I was alone and scared, and not until that moment did I know how much I wanted to at least not be alone.

It is good to be a friend of the attending, let me tell you.  He brought the shiny new ultrasound machine, not the old clunker that told the doctor all those months ago that A was dead. He was gentle, and kind, and attentive, and exactly what I needed. He didn't just do the one peak to make sure the heart was beating-- he sat there for ten or fifteen minutes carefully studying everything, watching my son wiggle behind my anterior placenta that with its movement-cushioning ways was the likely culprit behind that day's freakout. Twenty more minutes on the monitor and one fine-looking strip later I walked out of the triage room next door to the one in which they told me A was dead. I was light-headed, shaken a little.  But I managed to only be ten minutes late for dinner with a friend. And the next morning I took a deep breath and pulled that bellybra out of the drawer.

When A died, six months seemed like a ridiculously long way off, like it should be enough time to close the gaping wound, to let my heart scar over.  And now, nearly a year and five months out, what I am wondering is whether there is ever an end to the layers left to uncover. I suspect not so much.

How I Knew

For the record, I was never a Tom Cruise enthusiast, but I never in my life thought taking antidepressants would be for me.

For starts, I never suffered from depression.  Sure, I had the teenage angst years where I boo hoo'd over the boyfriend who dumped me, and the "what do I really want to do with my life" mindfuck when my graduate department admitted they had erred when they let in too many students ahead of me and there was to be no financial or professional assistance in the form of grants or jobs in my future.  Sure, I wrote overly-emotive poetry and listened to Pink Floyd's "The Wall."  I had a solid six-hour cry 18 months into my trying-to-conceive misadventure which was odd enough that my husband came home from work early to sit with me.  But I always felt a solid foundation going through these moments -- a sense that there was more to me than that.  I watched a friend crumble after failing her pre-lims, and realized she had wrapped her entire life -- her entire identity -- into this potential profession.  It hit me (as I passed the kleenex) that I was rather lucky:  I liked  this profession enough, but I had other stuff too.  I liked to cook, I liked to run, I liked to travel.  I had super friends, a fabulous boyfriend (who became my husband) and I figured if I had my wits about me, I could probably make money somehow.  Oh, and someday, I wanted a family.

Furthermore, and this is rather embarrassing, but I was never into mind-altering substances.  I  thought smoking was gross, and never even had the experimental attempt -- of either flavor.  Wouldn't know what drugs to take or where to get them, and I was not remotely interested, anyway.  I didn't realize beer tasted good until I moved to the midwest for grad school, and didn't like wine until I could afford something that didn't come in a box or with a black and white generic "Wine" label on it.

Finally, I liked having ultimate control of my body.  From very early on my life, I was a violinist and a soccer player.  So at a young age I figured out that if I practiced something for literally months on end, suddenly one day my fingers would click and lo, I could play the fingered octaves at the start of the Winiawski Violin Concerto.  I liked that if I did wind sprints around my block (two driveways on, two driveways rest) that come game time, I could throw my internal gear shift and move around someone.   I liked the way I could make my body do things, and there was no interest (no way, really) in allowing something to alter my mind that would mess this up.  I liked the control, not the fuzz.  I had no interest in being numb.  

What I failed to perceive, probably because of my immaturity, was that on some level my brain actually wanted to do these things.  That I liked doing these things.  It just seemed too easy that if I set my mind to a marathon, I could eventually make my legs follow.  And I did.  It all worked perfectly.

****

My husband and I joked (in the macabre way that you do, what with the terminal child in your arms) with each other during Maddy's brief week that we were going to need therapy.  But I think it really hit us, a week later without her, that we did indeed need something.  So we dutifully marched in, sat on the couch, and ground our way through the first awful few weeks of having so much to say and not wanting to say a word.

But I still didn't think I needed antidepressants.  Sure, I was depressed all right, my baby died!  Who wouldn't be?  This is just grief.  Everyone probably wants to crawl in a cave and stay there for 20 years.  I wasn't suicidal, I wasn't in denial.  I wasn't showering or eating much out of the coffee food group, but I was getting out of bed.

And there was Bella.  Two and half, still in diapers.  Not in daycare, because, you know, I was going to be home with the baby anyway.  She was my job, my responsibility.  She was my safety net, my bullet proof vest, and I strongly believe the candle which kept me from wanting to stay in my cave for eternity.  And for a good month or so, I could limp from my bed to her room, change a diaper, find her clean clothes, and start a day.  Probably one spent indoors, or sequestered in the yard, close to the door.  If we were lucky, a weepy trip to the grocery store.  Never the playground.  Never a playdate.  We let her activities lapse.

And one afternoon, Friday, about four weeks after Maddy died, she decided not to nap.

This was a completely unremarkable occurrence for a child who had never really napped in her lifetime, no different than any other day circa 1 p.m. where my tone of voice edges on exasperation.  But she would not acquiesce to quiet time, she would not stay in her room, she would not sit still and have me read to her.  And I was exhausted.  Of it all.  Of the grief, the loss, the aching, the trying, the getting up, changing diapers, putting my feet on the floor every morning with the realization that this was my life -- not some nightmare.  I collapsed on my bed, and could not get up.  I could not open my eyes.  I could not deal with my life.  I lay there glued to my sheets, with a toddler ambling about my house, and I could not call anyone on the phone, sequester her in the room with me.  Immobile.  Tired.  Comatose.

What stunned me was not so much that I couldn't get up, but that my mind ceased to ask for it.  My brain -- instead of screaming at me to lift my eyelids already -- shut down and concluded that this semi-conscious state was acceptable, regardless of the toddler who could possibly tumble down the stairs, walk out the front door, or figure out the safety latch under the kitchen sink.  My husband was at work, but I couldn't lift the phone.  Two neighbors had offered to come at a moment's notice if I needed a "time out," but I somehow forgot.  I could no longer rely on my mental faculties to prod me in the right direction and encourage the rest of me to move.  The part of my mind that once compelled me to run 26 miles now couldn't force me to lift my head.  It was . . . . frightening. Sorry Tom, if your brain doesn't send the signal to take vitamins or go for a jog, you ain't gonna.

First thing Monday morning, with resignation, I called my doctor for antidepressants.

A few of my friends had tidy little metaphors for exactly how ADs made them feel:  a tufted cushion to stand on; a buoy to keep their head above water.  I'm not really sure what my reigning metaphor was, but I can tell you this:  it slowed my brain way the hell down.  I went from racing from one deadbaby thought to another to actually being able to catch my breath between sobs.  It allowed me to sleep without tossing for two hours.  It allowed me to drive without breaking down in a (hazardous) blinding torrent of tears and shudders. It also diverted my attention from sticking on one ugly thought for too long:  going through the life support removal replay?  Mind quietly segues to lunch.

It allowed me to function.  I dare say, it helped me grieve.  I had a job to do, and it helped me do my job.  Although my brain never went to the place of endangering myself or Bella with weapons or whatnot, by having my body do nothing, it was in fact endangering us both.  The antidepressant did not make me numb, it did not make me miss Maddy any less.  It by no means made me happy.  It made me get up, it made me move when I needed to, it helped me pay attention.

After a few months, it became readily apparent to me that I had lost my short-term memory --  most likely from the shock of Maddy's death, but possibly abetted by the ADs.  I also noticed when I went to play the ABC -game ("Your name?  Gah.  Lessee:  A, Alice, Allison, Angie, B, Barbara, Betty . . . ") that my mind would not stay on task and focus long enough to get through the C's.  I'm guessing the ADs saw this as anxious fretting and tried to shut my brain down and think about puppies or daisies or something, but it became increasingly frustrating to the point that it made me overwhelmingly anxious.  Heart-racing, short-of-breath anxious.  Given that I felt a bit better all around anyway, I quit taking them at six months.  I haven't felt like I needed them since.

It probably bears repeating that I didn't feel I needed them until a good 4-5 weeks after Maddy died.  If I were to search around in med journals, I bet I might find some reason for this.  I don't think it's unreasonable to think that our body produces hormones and adrenaline after childbirth in order to get us through the first grueling sleepless weeks of our babies' lives.  I know the act of breastfeeding produces oxytocin, and I'm willing to bet letting down does a bit too.  All this conspires to both give us an amount of energy and simultaneously relax and think, perhaps, that we can do this just fine, thanks.  The first month or so many of us are also gently supported by the onslaught of cards, flowers, donations, email, phone calls, meals, and friends and family.  They too dry up about 4-6 weeks later.  I've seen a number of women here on the 'net crash weeks to months after the event.  It's not unusual.  And don't think if you haven't sought help by that point that somehow it's embarrassing if you do now.  It's not sliding backward, it's just what's happening now.

ADs are not to be taken lightly, in either direction:  you may not need them, but grow to rely on them.  Conversely, you may need them, but fear or not understand them.  Either scenario is dangerous in my estimation.  I can't tell you exactly when and if you need them, or when or if you should go off.  In my mind, it was crystal clear:  the day not only my body, but my mind stopped responding was the day I felt I needed them.  The day my mind began to rebel against their function I got off.  To quote every big-pharm commercial:  see a doctor, but please see one, if you think you might need additional help, or need a different dosage or flavor with less side effects, or or if you're ready to leave them behind.

I never, ever thought I'd need ADs.  I had seen them work for others, so I wasn't opposed to them as a rule, but just didn't think I was the type.  I had a foundation!  I was more than this death!  I had a life to live!  I've run a marathon, for Pete's sake!  But all that meant nothing when I realized I -- my mind -- had neglected Bella for an afternoon.  And not cared.  And there was no way I was going to let it do that to either of us again.

The luxury of choice

I recently told a friend, who happens to be a former colleague, that I watch House for professional development. She laughed. Nevertheless, it's true-- my training focused on the molecular level, and not until my current job did I need to know much about organismal, particularly human, biology.  Medical story lines on the show are pretty well researched, and they make interesting and weird connections-- all pluses in my book. But the real reason I can watch the show in that particular way is the writing. No, not because it's that good, or because they place all the clues out in the open. No, it's because they are forced to write the episodes starting from a medical scenario. 

What that means is that while they can and do develop the characters of the doctors on the show to reveal facets of personality or elements of background, to fill in the dimensions, to make them believable, at least to a degree, they have far less flexibility with the patients. If the patient in episode N needs to collapse unexpectedly in the opening sequence, pee blood right before the first commercial break, go into v-fib seven minutes later, fail to respond to the first several treatments House was sure were going to work, lie about something or other, and finally recover or die with enough time to spare to give some  screen time to the storylines about doctors' personal lives, well, that just doesn't leave much room for dramatic  and believable character development, does it? Which suits me just fine. If I don't buy the patient as a real character, I can concentrate on the medical aspects. So yes, professional development. With a side of ahem... eye candy, as my sister calls them.

One teeny tiny complication there-- they do develop their doctors as characters. Which is normally a good thing in a TV show. Completely messes with my frame of reference, though, when they make one of their own a patient. Can even make me cry when they then kill her. Yes, the season finale. Very well done episode, wherein they try and fail to save the life of one of their former colleagues who is also the newish girlfriend of the title character's best friend.

Tears show up for me a lot these days. Any report about collapsed schools in China is guaranteed to make my eyes water. Music can get me to well up, and I won't even watch some movies that I expect to be upsetting. And yet, over the last week I watched over a season of House on DVDs (thanks, sis), learned a bunch of new stuff, made some cool connections with the things I learned over this past semester, but didn't cry once.  I cried over that season finale, though. Couldn't articulate why. So I watched the second half again. Brilliant move, I know. But my need to know what was affecting me so much was greater than my need not to be affected again. I guess I can be analytical like that.

The second time I saw it, I knew right away. It was the dying doctor. Not that she was dying, but that she was making a choice, and articulating that choice. Her boyfriend asking her why is she not angry, why is she ok with dying. Because, she says, that is not the last emotion I want to experience.

She was dying. There was no way out. No choice, it seems. But she found something she had control over, and she made a choice. And the reason it made me sad, profoundly, deeply, for days after, is that I realized not everyone gets to make choices.

One of the things I try to do in my parenting, one of the things I articulate for my daughter is the issue of choice, of responsibility, of consequences.  Most choices children make are not of great consequence. You can choose to wear X or Y today. You can have this or that for dinner. But slowly, as they grow, so do their choices, and the consequences of those choices. Watching my daughter make increasingly more weighty choices has been one of the subtle pleasures of parenting.

I have appreciated for a long time,  from the very beginning, actually, that after A died, we did have some choices.  I chose to start the induction that same night, and to eventually accept pain relief, even though I wouldn't have likely for a live birth. We chose to name him, to hold him, to take pictures, to follow our doctor's recommendation and ask for the autopsy. We chose things after that too. Telling Monkey the truth, but not taking her to the funeral. Leaning on our friends, but not letting them come to the funeral either. Going back to work when each of us did. Many, many choices.

What I didn't appreciate, the way I never looked at this before was that making choices is yet another thing my son never got to do, will never get to do.  Babies have preferences, but no choices. His entire human existence passed, and he had no control of it, he never got to choose. I don't know what the last thing he experienced was. I do know he didn't get to choose it.

Maybe I am nitpicking. There are so many things that our babies won't get to do, so why am I focusing on this? My son also never drew a breath, but that thought has never made me sad for days on end. What is it about choice that makes it so fundamental to me, a loss in its own right? Perhaps it's all about what choice means to me. Autonomy, ownership, even avoidance of guilt. Because to me making a thoughtful choice means making the right choice.

I know that not everyone feels this way about having choices. I know people who hate having them, hate having to make them. So this is what I wanted to ask you today-- how do you feel about choices? Are they a cornerstone of human experience or a giant cosmic torture?