Aug
21

Part Three.

When Simone was in the hospital, my emotions were mostly practical ones, tied to her condition: fear and hope, often all twisted up together. But sometimes there was something else—I was angry. Often I didn’t realize it until I was on my way to see Simone, walking past a room with a big, healthy-looking baby in an open-air crib, or being nursed by its mother. I would feel my eyes narrow involuntarily. Simone was having surgery, stumping nephrology, failing CPAP trials, too fragile to be held. I saw the parents of these fat, four-pound babies looking terrified, and instead of sympathy, I felt scorn. You have no idea, I thought, with a cruelty I am ashamed of now, you know NOTHING. And then I strode past with a tight jaw to Simone’s room, to peer at her monitor and whisper into her porthole.
Quite a bit of my anger was directed at the chaplain, a perfectly nice woman who came around every once and a while to talk to me about my “journey.” Now, I do not happen to believe in god, but I have no problem with those who do. I loved hearing that someone was praying for Simone, and I even like to think it helped, all those people all over the world thinking of her. But something about this woman rubbed me the wrong way. Maybe it was the tiny, useless backpack she wore, or her constant, impatient-making insistence on asking about me, when I WAS FINE, IT WAS MY BABY WHO MIGHT BE DYING. I was rude when she visited—or as rude as I ever am, which mostly involved not offering her anything to drink—and I sat there with my teeth clenched, just DARING HER to say anything to me about “God’s plan,” or “finding meaning.”

I have always found the idea of “finding meaning” in a tragedy to be rather repulsive. As if Ames’ death and my daughter’s potentially crippling prematurity were ultimately about me, about teaching me some lesson about the resilience of the human spirit. The very idea makes me feel like taking a shower, and then possibly burning a stack of cloying angel-themed poetry. I wasn’t interested in meaning. But I did want to find a cause.

For your reference, there is no way to make the reading of an autopsy report festive. Believe me, I tried. I received the report, after many frustrated phone calls, more than four months after Ames’ birth. My perinatologist was kind but busy, and not particularly helpful when it came to interpretation of the findings. There is more to being a doctor than vocabulary, and though I understood the words in the report, I did not understand their significance. But happily, my brother had the foresight to become friends with a medical examiner, and she agreed to come over and explain it to me.
I chilled wine, I washed the good glasses, but it would have taken something with more than 12.5% alcohol to render the situation anything but awkward. “Welcome to my home! Come, let us read about the autolytic changes to my son’s brain!”

The doctor at our 20-week ultrasound had been right all along: there was not a thing wrong with Ames; his chromosomes were normal. Given different circumstances, he would have flourished.
Ames’ placenta showed “severe, acute chorioamnionitis,” an infection of the placenta and membranes. His umbilical cord was thin—as small as .3 cm in some places—and his placenta was only 77 grams, well under the 10th percentile. For that matter, Simone’s placenta was small as well, only 116 grams at nearly 26 weeks. When she was born, they said she seemed younger than her gestational age. Ames measured 20 weeks. The autopsy report states: “The etiology of intrauterine fetal demise of Twin A is likely due to the severe chorioamnionitis.” However, there was no fetal infection. The medical examiner I plied with wine believes the infection compromised Ames’ placental function, clogging the vessels, depriving him of oxygen, bloodflow, and nutrients. And that is what killed him. I wouldn’t imagine it is a pleasant way to die.

It is impossible to know for certain, of course. A month had passed since his death, and Ames’ sac had been ruptured for almost half that time. The infection could have been introduced post-mortem. But the medical examiner does not believe that was the case. It is nobody’s fault, if by fault you mean intention, but the fact remains that my body’s job was to protect and nourish its charges, and instead it deprived one of sustenance. There were other contributing factors—I had gestational diabetes, which affects the formation of the placental vasculature. I was on prednisone for the first 18 weeks to prevent miscarriage, and prednisone is a drug that both decreases glucose tolerance and can increase chances of infection. I was diagnosed with a bacterial infection at 17 weeks, and though I was treated with a course of Flagyl, I was never rechecked. I had trouble keeping the medication down. Maybe I shouldn’t have been on the prednisone. Maybe I shouldn’t have stopped the prednisone at 18 weeks. Maybe I pulled dirty underwear out of the hamper one morning when I was out of laundry and gave myself an infection. Maybe I should have been more insistent about the amount of pain and pressure I was feeling—by 22 weeks, I could barely walk from my desk to the bathroom. Maybe I should have insisted upon heparin. Maybe, maybe, maybe. It is useless to think this way, but inevitable.

In the end, an autopsy report has a sort of poetry:
“The fetus is well-formed.”
“Right foot length: 3.1 cm”
“Hair follicles are present on the scalp.”
“The ears are appropriately positioned and exhibit normal folding.”
“The lungs are unremarkable.”
“Fingernails and nailbeds are present.”

Mosaic

I’ll wrap this up tomorrow.

By Alexa | Posted in Ceci N'est Pas Une Ecrivaine |