An Open Letter to Folks Who Have Experienced an Ectopic Pregnancy

Today I am writing a letter to folks who have experienced an ectopic pregnancy, because I experienced one and one of the worst parts of the entire thing was how lonely it felt not to be able to find any stories that looked like mine. I’m not trying to win any Pulitzers here so I’m going to open with the end:

• This is how I described myself on my birthday last year, enumerating what I was grateful for: “I am impossibly happy, and I laugh (loudly) every single day of my life.”
• Seven months ago I got pregnant and my husband and I danced in our kitchen and it felt like the rest of our lives had finally gotten here.
• Five months ago we found out that the pregnancy was ectopic and we had to terminate our baby. It was the loneliest experience I can imagine, and almost unbearably painful.
• Five months later I would continue to describe myself as an impossibly happy woman who laughs (loudly) every single day of my life. Now, more than ever, I am able to breathe life and love into the layers of the words “impossibly happy”.

This essay is hard to write and terrifying to share but I am publishing it because I would have given anything to read those four bullet points all in one breath while this was still unfolding. I am writing to the me that lived through January 2018, and though I can’t go back and give myself what I desperately wished for, I can put it into the world and give it to the women that will come after me.

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It started with bloodwork. Mine was never quite right: the numbers were going up, but not like they should. After a while spent getting my blood tested every three days, my doctor’s office finally called me, late in the afternoon on a Wednesday, to say that I needed to go to the nearest emergency room and check myself in.

“Can I wait until tomorrow?” I remember asking. “I have class tonight and I don’t want to miss it.” There are a lot of moments in this story where I want to go back and hug my past self tightly, and this is probably the first one. I think it’s safe to say that this is the last clear memory I have of the self I was before I understood how wrong things had gone.

“No,” the nurse replied, after a long pause that helped me understand everything I hadn’t been able to, moments ago. “No, the doctor thinks the situation is emergent, and she thinks you should go now.”

Many awful things happened next. The first awful thing happened that evening when a doctor looked at me and said, “There’s a slight possibility that you’re having a miscarriage, but we think it’s much more likely that your pregnancy is ectopic.”

In a similar moment to having asked earlier whether it would be okay to wait until tomorrow to check into the emergency room, I asked: “Is there any chance that the pregnancy is viable?”

“No, we don’t believe so,” the doctor replied, and the only good thing about those words is that they gave me something real to cling onto and cry over for the first time.

An ectopic pregnancy occurs when an embryo implants outside the uterus — in my case, in my right Fallopian tube. It’s a relatively rare event — only about 1–2% of pregnancies are ectopic. The first autocomplete Google provides for “ectopic pregnancy” is “Can you save the baby in an ectopic pregnancy”. The answer is no.

An ectopic pregnancy, as my nurse had implied a few hours ago, is an emergent situation; without intervention, the embryo’s continued growth can cause any amount of damage to the affected organs. My team, after reviewing what felt like an enormous array of test results and ultrasound images, decided to attempt to resolve (a word which I still find horrifying, though I understand its utility here) the pregnancy using methotrexate, a chemotherapy drug that ends a pregnancy by stopping the growth of the fetal cells.

The worst part of the entire thing, and probably my life, was the moment where I had to sign a form authorizing the procedure to terminate the baby inside me, the baby that we’d pinned so much onto, the baby who would have occupied the nursery we’d spent a month planning, the baby that would have been the first grandchild for all of our parents and who would have made all of our siblings aunts and uncles for the first time.

“You did the right thing by coming in,” said the kindest doctor I’ve ever seen in my life just before squeezing my hand and ordering the shots. “You did what you needed to do to take care of your baby. You’re a good mom.” (I sometimes wonder whether she understood the way that sentence would burrow into my mind and anchor the next week.)

In some instances, mine included, methotrexate is not enough to resolve the pregnancy. Three days later a sharp overwhelming pain in my right side woke me up in the middle of the night, and although I knew something was wrong, I refused to leave the bed until my husband scooped me into the car and drove me back to the same ER that, days earlier, tried to terminate a baby who wanted to live as much as I did.

This time, there was no battery of tests. There was a single ultrasound immediately after the doctor palpated my right side and I gasped, and then, so much faster than anything was decided three days before: “You need surgery, right now.”

And so, quickly and quietly, this is how it ended. I woke up a few hours later with a sore throat and a foggy head, and I said: is it over?, and the nurse said: yes. It’s over.

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The nurse’s words were true and untrue. All at once, everything was over — and yet, when I woke up at one in the morning, it also felt like everything was just beginning.

I think I knew I would someday write this essay the first time I tested out that shaky, terrifying sentence — “I killed my baby” — with someone who loved me deeply, and then that person, in all of their love and well-meaning, without understanding that my life had been indelibly changed by breathing those words, brushed the hair out of my eyes and said,“Sweetheart, it was the only thing you could have done.” And I thought — I know. Believe me, I know. Believe me that there is no one on earth who understands how ill-fated my baby’s life was, from the day it implanted outside my uterus, better than me. Believe me that there is no one on earth who understands the impossibility of its tiny life better than me.

Believe me, too, that there is no one on earth who understands the duality of this impossibility like I do; its heart did not beat for very long, but when it did, it beat inside of me. The deep, steadfast inevitability of my baby’s death was somehow not a comfort when it was me that had to order it, after weeks of wondering whether it would look like me. If I were with you, and you looked up at me and you murmured, “I killed my baby,” I would hold you tightly and I would tell you what I wanted someone to tell me: I know. I know. It’s not fair. It hurts so much. It’s not fair. I know. I know.

So this essay, at the end of the day, is an essay made up of the things I wish I could have found when I was Googling endless permutations of “ectopic pregnancy will I ever be happy again” for what felt like an eternity. And that is thing number one: it’s not fair.

Thing number two — this road is lonely — is complicated, because the road is lonely in addition to being full of people that love you very much. Their love for you doesn’t change the fact that they are just not going to know what to say. I say that it’s complicated because it feels strange to be adrift while surrounded by so much love. It’s as if the world understands that you are beginning to pick at the threads of fundamental unfairness, and, in an effort to silence your existential doubt, sends you a wave of support (as if you wouldn’t have rather had a living baby).

To be clear: I was grateful for the wave. Truly, I did not understand the depth of possibility for gratitude until my own community rallied around me. I remember every single person that was kind to me in the aftermath of such a horrible few weeks, and the knowledge that they were there for me — unearned, like a foundation underlying every piece of me — fundamentally changed the way that I see the universe in a way that likely balances the scar left by the wild unfairness of it all. Kindness I could never have imagined, and would never have requested, seemed to burst out of every seam and so I knew, in the strangest way, that I would be okay.

And yet, at the end of all this, what I found is that to experience an ectopic pregnancy was for me an exercise in feeling loved but unheard, and understood only by a few people. I was grateful for the women that shared their stories of loss but frustrated by the fact that none of their stories sounded like mine. It was unfathomably sad to me that in sharing the tenderest, dearest pieces of themselves with me, so many women had invited me in to a story that I still felt I couldn’t share. In the end, whether the community was filled with new mothers, excited to hold babies that breathed and burbled and lived, or with mothers who grieved miscarriages, I always felt like I was on the other side of a window, peering in where I didn’t belong.

In the weeks following this entire experience, I would have given anything to know a woman who had experienced the same thing I did and come out on the other side feeling like the great dividing line of her life wasn’t between the part of her that had been happy and light and the part of her who felt drowned every day by this sadness. I would have given anything to hear a story that sounded like mine without being qualified by, “it’s not quite the same, but…”.

And so, because it would have been helpful to me, here are things three through six — a few things that are true about me, in addition to everything you’ve read so far:

• I am happy. Every single morning that I wake up, I am glad. Most mornings, I look forward to the future — even though I am unsure whether that future includes me being a mother to a living baby.
• There are times where I do not think about my baby. They do not make me feel guilty.
• There are many more times where I do think about my baby. They do not make me feel too sad to move around in the world.
• This loss did not end my marriage. In fact, I think it has actually made it stronger. I read so many horror stories of marriages that didn’t survive the grief of pregnancy loss. Hearing about even one marriage where people came out the other side loving each other even harder would have been a game-changer. If this is you I would like to take a moment to change your game: I literally said out loud to my husband the day after surgery that even though everything else has been terrible, I would never have believed before it that I could possibly have loved him this much. There is a dimension to the way I love him that would never have existed without this.

Let’s go back to that “great dividing line” for a moment, and to the idea of grief, and to the idea of adding dimensions to our lives. In our hearts we know this, but it’s worth saying aloud: there is no way “through” or “out of” grief. There is only integrating this sadness into ourselves and moving forward anyway. For me, too, there has been no moving “around” grief. There has only been moving “in spite of”, or “in addition to”. I knew all of this the morning after my surgery and I watched light stream into my window and I was so scared that the person I woke up into that morning would feel strange and unfamiliar. Because I knew: I am wholly different now. And yet, I knew: I’m still the same. I am still the same person I’ve spent my whole life fighting to become. There is so much sadness, all of it unfair — and all of it able to be carried through, and fully integrated into, myself. The same strength I’ve cultivated all these years is the way into carrying difference into a place that feels like home.

There were things that felt different about this grief. It was the most isolating grief I’ve ever felt, and it’s probably the loneliest I’ve ever been. I am always a terrible friend when I’m grieving but this was something else altogether, because the more I loved a person the more time I had spent imagining their relationship to my baby — but that dream hadn’t been real to anybody but me. I was the one who had carried it while it lived, and I was the one who lost a literal part of myself when it died. One of the loneliest things about this is that, no matter how much they love you, most people will not be able to share this with you the way that you want them to. You will feel, often, like your grief is too much for the people that love you most.

Your grief likely is too much for them, for now. Your grief likely feels too much for you, right now. The first time I walked into the room that my baby was going to grow up in after I knew it was over, it was a Thursday morning and it was snowing and I had made myself a cup of coffee and I sat down and cried on the floor for forty-five minutes, and I knew that there were zero people on earth I could call who would understand the magnitude of what that room meant for me — and of what it meant that I had, however helplessly, chosen this loss. So I sat in it and I endured it on my own.

I went into that room the next day, and the next day, and the day after that, and for every single one of those days I sat on the floor and I cried. I’m not here to tell you anything magical about any part of this (because every part of it is terrible and unfair and you do not deserve a single moment of it), but what I will tell you is what I wanted someone to tell me: someday, my dear, you will be able to sit in the room and the pain will not crush you. And: if today is not that day, that’s okay; it doesn’t mean that day isn’t coming. And, most importantly of all: when you sit in the room and the pain doesn’t crush you, you will love your baby just as fiercely as you ever did.

The pain fading does not mean that the love faded, too. Your love for your baby is more than the pain you felt when your pregnancy ended.

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My barometer for sharing this more widely has been that I would write about it when it felt like something that had happened to me, rather than something that was happening to me. This is part selfishness: I couldn’t stand the idea of talking more widely when tears still came so readily. I would like to believe that there is an altruistic piece as well. I wrote what I wanted to read while I was in the valley: a story with an ending.

What I would tell you is that there is not an ending, really, other than to say that all of the sadness and grief I experienced over this loss exist now alongside all of the joy that came before — and, probably more importantly, also alongside all of the joy that has come since. And there is so, so much joy. As I move more and more firmly into the realm of something has happened rather than something is happening, I can tell you that it has been possible to make space.

I would tell you, too, that there are some things that never felt okay to say out loud until I was done hurting, because they felt so hurtful that it felt like saying them while I was sad was just spiteful. The hardest thing of all has been to admit that I am jealous of people whose pregnancies ended in miscarriage. I am jealous of people who got to experience the death of their child as something that happened to them, rather than something that they had to facilitate. I am jealous of people whose bodies are whole after the death of their child — people for whom the death of their child did not take a literal piece of themselves along with it.

And at the end of the day, this confession is another reason I am writing this: the second I said that out loud, the jealousy faded into a sad recognition that our stories are different, but loss unites us. There is still a spark that tugs at me, but the anger went away when I finally spoke it out loud. I found that it was easier to reach out through sadness than it was to reach out through anger. I found that I couldn’t connect over anything until I said it out loud. So, I would tell you: say it out loud.

The last thing that I would tell you is likely the most important: there are not that many of us. This is not a common story. I felt so angry and powerless, the entire time, because I had exactly zero risk factors. It happened anyway.

And this brings us back, as ever, to the very beginning: to the heartbreaking, terrifying realization that life isn’t fair. You cannot work long enough, or try hard enough, or be good enough to be guaranteed that your baby will live and be healthy. The world does not owe you that — or if it does, it is a bad debtor.

Viktor Frankl has a quote about the vast unfairness of the universe that I have always loved very much: “We can discover this meaning in life in three different ways: (1) by creating a work or doing a deed; (2) by experiencing something or encountering someone; and (3) by the attitude we take toward unavoidable suffering.” It will never be fair that we lost our baby. No lesson will ever make it worthwhile or okay. The devastating work of the last six months has been to make meaning of the loss while recognizing that the work of making meaning is not the work of moving on, or of wiping the slate clean. The work of making meaning lies in the attitude we take toward unavoidable suffering. In this case, for me, the work begins with breathing the words out loud.

Tomorrow I turn 29. I could not be more excited for the rest of my life, even as I begin to understand that I will carry this loss forever. I am, most days, happy. I am, all days, glad that I was born, and glad that I am alive. Life isn’t fair, and the work ahead is to love it anyway.