Choosing Life: The Ultimate Sacrifice

My child’s heartbeat was the death of me.

Aisle 7 held the same anxiety in my thirties as it did in my teens: feminine hygiene, feminine protection, sanitary protection, family planning — that’s the one that made my heart skip and then drop, like an elevator trying to locate the right floor. It looked like the cereal aisle — endless square boxes with brightly colored labels in cheerful fonts, each beckoning you to choose it and not its competitor.

“First response,” said the blonde woman standing beside me, observing the line of pregnancy tests as if on the Western Front. A moment later, she reached up and pulled down a long, pink box with a dawning gold sun and “Six days sooner!” emblazoned across the top. “I don’t know if I have it in me to know,” she confessed with a sigh. “We’ve been trying for so long.” Before I could respond, she smiled wistfully, then disappeared into aisle 8.

I scanned the shelf fixating on the empty space left by her test of choice. I too was uncertain if I had it in me to know — only for very different reasons. “I can’t be,” I thought to myself resolutely. “There’s just no possible way.”

And yet life has never failed to surprise me.

Now home, I sat paralyzed on the edge of the bathtub, biting my cheek as white slowly morphed into pink. One line. A pause. A deep breath. A prayer. It was the same unfolding of thoughts and emotions as that time in my late teens when I was reminded that nothing in life is “foolproof.” As I watched the tiny plastic screen, counting the seconds until three minutes was up, this time a second line began to appear. I closed my eyes, rubbed my eyes, then shook my head, certain that fear had tricked me into seeing something that wasn’t there. When I opened them, my heart dropped again; the lines were crisper than before.

“It’s faulty.” “I’d spilled something.” “I’d eaten something odd.” My mind raced through the possibilities — the absurdities — that could have brought the second line into being. I tore apart the pink box, yanking out a second sealed package. Slamming consecutive glasses of water, I repeated the process — prayers and all. But all I was left with was four pink lines.

I don’t know that I have ever cried as hard or as much as that moment. I’d ended a marriage in my twenties, walked away not just from one person, but an entire community, not to mention a world of hopes and plans, because I knew, at a cellular level, it wasn’t — we weren’t — right. I’d lost a family member in a commercial airline crash off the Pacific. I’d lost someone who was a like a brother to me to suicide. I nearly lost my mother to breast cancer. And I almost lost my own life — twice — not even a year before to two heart attacks in one week. And yet for all that pain, this was worse, because I knew that bringing this pregnancy — this much desired life — to term would, in all statistical likelihood, result not only in my death, but also the death of my unborn child.

******

A SCAD (aka Spontaneous Coronary Arterial Dissection) is what I had — what caused the attacks — what convinced all manner of medical professionals that I should not get pregnant. “It’s rare,” they explained, as I lay in the ICU, waiting to hear why my coronary arteries had suddenly torn open, blood poured in, and a section of my heart began to die. “We don’t know for certain what causes SCADs, maybe stress, maybe extreme exertion, maybe…pregnancy.”

The room became suddenly silent as death. I knew what coming.

I shouldn’t…

“You shouldn’t…”

“Get pregnant,” we said in unison.

Their reasoning was that elevated estrogen can be associated with softening walls of the arteries in some people, and that arterial dissections are, when found in young women, often associated with pregnancy. To have had one, let alone two dissections prior to pregnancy was extraordinary, and not in a good way. My head physician admitted that the medical team was flying blind with only a little case literature to go on, but said plainly, “If you were my wife or daughter, I would absolutely advise against getting pregnant. And should it happen, it would be considered a clear threat to the life of the mother.”

******

I collapsed onto my bed with the plastic test boasting two pink lines in hand, unable to form words let alone thoughts.

It’s hard to describe what it feels like when time stops. For me, at that moment, like that day in the ICU, a preternatural stillness filled the room. Gone was any sensory experience of sight, sound, touch, or smell. I was in the world, but not of it. The existence of all that surrounded me — walls, dressers, chairs, windows, chirping birds, a husband yelling at me to tell him I was actually okay and not dying, like my apparent scream might have indicated — were more illusory than reality. I’ve never done hallucinogenic drugs, but in that moment I could see the appeal. For somewhere between a second and eternity there was no awareness of the despair that filled my heart when it became clear as pink that I was, in fact, pregnant.

I had wanted a family of my own all my life, wanted to be a mother, wanted to take what I had always known was an innate nurturing side and put it to good use. I had postponed family in order to “find me” and find “right,” and left my first marriage to do so. But I had put in my time, succeeded in my effort, and come full circle. I was finally doing the things that mattered to me most — writing and counseling, specifically related to resilience. I was remarried for nearly a decade. And after years of moving around, my husband and I had decided to plant roots and buy a house in order to house the family we had agreed to start. It was a big deal — a settling after much unsettledness. We threw ourselves into fixing the place up with the passion and focus we knew we were capable of. And literally on the day that all the renovations were complete, I had a heart attack.

When you’re thirty-three, healthy, happy, and hopeful, the world really does feel as though it’s your oyster. I had traveled far in my life, both literally and figuratively, seen the heights, felt the depths, tacked as necessary in order to have the wind in my sails. But as I continued to lay on the bed that day, crying as though life depended on it — because it did — it was as though I’d been tossed out into the sea without a vest or dinghy or buoy to hang on to.

******

“There’s always adoption or surrogacy,” said everyone who had heard about the news of “no pregnancy” post-heart attack, their smiles and wide eyes and successive head nods exuding the optimism they thought I needed. But to be honest, the path forward in terms of a burgeoning family was the last thing on my mind — at least just then. It was all I could do to heal from the assaults on my body, adjust to a slew of medicine, especially a triple blood-thinning regimen that reduced me to a walking bruise, and try not to pick up anything over the weight of a gallon of milk, to say nothing of trying to make sense of what, by all accounts, was still insensible.

As the year mark came around, my husband and I started having the “should we freeze eggs and sperm” conversation. We even got the name of a highly distinguished endocrinologist who could guide us on this journey — should we choose to embark on it.

We never made the appointment. Instead, I found myself in the building next door — in the high-risk OB/GYN office having a consult about the remote possibility of carrying the life then growing inside me to term, as well as how that effort might effect my own life.

“This is some situation you’ve gotten yourself into.” These were the words the “renowned” head of Mass General Hospital’s OB department said to me when he walked into the exam room, my chart in hand.

What did you say?”

I couldn’t take my eyes off his. I was unable, unwilling really, to believe that a professional, let alone the head of one the critical care departments at one of the best hospitals in the country, nay world could actually be uttering these words to a patient. Condescension dripped from his pores, though he was seemingly unaware of it, like someone who has a bad sense of smell and forgot to apply deodorant that morning.

I felt like a naïve fourteen-year-old runaway who had gotten herself knocked up by some guy clad in tats and chains at the Flying J rest stop off Route 80 who wanted nothing more than a sweet piece of ass. Nonetheless, I indulged his litany of medical questions, which curiously, had more to do with my heart attacks than the possibility of seeing this pregnancy through. In the end, he closed my file and tossed it on his desk.

“Bad idea. Too soon. Too much damage. I had someone die on me with this same thing a year ago. She was pregnant. Baby didn’t make it either.”

I walked out of the office before he did, offering little more than a grunt, and made my way to the parking garage where I proceeded to cry, loudly enough that at one point a security guard came over and poked his head against the driver’s side window and asked if I was okay.

On the way home, I made one last-ditch effort. I called my cardiologist and explained the situation, hoping against hope for a miraculous volte-face.

“Would you still counsel the same thing today as you did that day in the hospital — if it was your wife or daughter?” My heart pounded beneath my shirt.

“I wish I could say what I know you want to hear, but yes, my advice would be the same. In my opinion — medically, ethically, and personally — the chances of a dissection happening again under these conditions are astronomically high. Pregnancy, at least at this point, would likely be life-changing, life-ending…for both of you. But we’ll support whatever choice you make and help however we can, if we can.”

******

Choice. The word stood out like a neon sign on a dark and desolate road. Was there even a choice to make? I obviously knew to what he was referring — abortion, or termination if you prefer a gentler word. Either way it was ending the possibility of the life growing inside me.

Perhaps because when I was young and intentionally, stupidly didn’t fulfill my potential, at least academically (I told my teachers I was dumb and didn’t belong in the TAG program they put me in, and as a result fulfilled only my own prophecy), I have a heightened sensitivity to people and things being stymied or unrealized. This situation was the Everest of unrealized, in every possible way — and to be honest, simply more than I could bear. I acknowledged that not having the abortion was tantamount to suicide. And yet having it was also a life-denying sacrifice. Either way I played it, all I could see was death.

I broke the news to my parents who were equally heartbroken — for me mostly, but I knew for them as well. I am an only child. This might well have been the one chance they had to have a grandchild, and yet I was their child. They had brought me into being, loved me, cherished me, invested in me, supported me in ways that I can barely put into words for nearly thirty-four years. Could I really risk taking all this away from them if I died?

The same was true for my husband. We had been through nearly everything a couple could go through in our time together — good times and bad, sickness and health, etc., etc. He was the one who helped me to rediscover the potential that I had thrown away all those years before. He supported me in my decision to go back to college after a series of false starts and dead-ends. He was there swinging me around at not one graduation, not two, but three in six years, his eyes filled with pride when they announced my name with honors. He was the one holding my hand in the ICU, whispering over and over, “I love you more than life itself. Please don’t die.”

This “choice” was not mine to make in a vacuum. Whatever I did would affect each of them as much as it did me. And still there was something more.

I had worked so hard in the wake of my heart attacks to live — for my parents, for my husband, for me, but also for life itself. And I had done it. I hadn’t just survived. I was thriving. I had finished and published two books on resilience. I became actively involved in the heart health community, volunteering with patients, teaching, and giving speeches. I had a private practice counseling to individuals and families in crisis and transition. I was crafting a life that was incredibly meaningful and one that had taken a long time to build. “Should I throw it all away,” I thought, “all of the good, life-giving efforts for the inevitability of death — not only my own, but also the one I was carrying? What about the so-called sanctity of life?”

******

After I hung up with the cardiologist, I dialed another number, this time an old friend and former academic mentor — he was also a priest.

I was raised in the Catholic tradition. And while never a holy roller (more like “CCD” — Continuing Catholic Development — dropout), I did attend Boston College, a Jesuit-run university, where I eventually studied theology — world religion specifically — the human condition if truth be told. And yet for all of this study I had never adopted any formal practice or community, nor did I necessarily identify as Catholic, let alone religious. But I respected — and still respect — much of the tradition. What’s more, I respected this man for what I had always experienced to be his unfailing wisdom. I figured, what would it hurt to lob in a call.

What did I want him to say? I honestly didn’t know. Was I looking for permission to have the termination — for him to tell me I wasn’t a “baby killer” and “going to hell?” No, decisively not. Fire and brimstone aren’t my idea of “divine love.” Was I looking to “confess” my sins? Not a chance. Creating life with your husband could never fall into that category. Was I looking for one person who would tell me not to have the abortion — because, given his vocation, what else could he say? Again, I don’t know. What I do know is that when he picked up the phone, I broke down — for the second time that day — as I relayed the situation.

Father H (I’ll call him) listened patiently, as was his way, and in the end, said the most insightful, heartfelt, and surprisingly supple thing one could: “Creation is a mystery, and comes in many forms, Michele. You have to choose life.”

******

Choose life. How these words have rooted themselves within me.

When I conceived I was thirty-three, ten months post-heart attacks, and still somewhat of a physical mess. I had finally made it to a whopping five miles per hour on the treadmill at Cardiac Rehab. I had just stopped fainting in the hall or on the stairs or just about any place really, due to a much needed reduction in my dose of blood pressure medication. Needless to say, the idea of sex was exhausting, let alone concerning because who knew if, at that point, an orgasm would cause another dissection. Add to this that my husband was fourteen and half years older than me and Type II diabetic. Let’s just say it was a very “down” time.

When so many of my peers, healthy ones at that, were struggling to get pregnant, somehow I, with all the odds stacked against the situation, managed to. It was the closest thing I knew to miraculous conception. All I could think of was how could something so awesome and awful coexist? I wanted the child that would result from this pregnancy. I had created many things in life, and quite possibly this could be the best of them. And I didn’t want to die. I had too much to live for, too much to do; too many people who loved and depended upon me too much. But sadly, these two desires were diametrically opposed.

If we’re wise, we make — or at least we try to make — the best choices we can, based upon the best information we have available to us. Unfortunately, human beings are not omniscient or omnipotent. Everything pointed to the heartbreaking reality that the child within me was fated from the start. She couldn’t live without me, nor could she live with me. And I couldn’t live with her, to my deep regret. But I could live alone.

I had to choose life.

******

I can only imagine the heartache of women who have a fetus die in utero; what could be more agonizing than literally carrying death? But carrying a living fetus, that you know can’t reach its potential because of your so-called “choice,” bears a similarly excruciating burden, only in this case it is grounded in immeasurable guilt and shame. And mine was no exception.

Because doctors told me that for medical reasons related to my health, I’d have to wait until I was at least thirteen weeks before they could preform the termination, the next few weeks felt like living on death row. If time seemed to have stopped when I first learned that I was pregnant, it now dragged on at a damnable pace. I had to have ultrasounds that produced images of a little head, spine, and fingers, and heartbeats with waves that swished and pounded no differently than mine. I prayed with a fervency I never knew I had that they’d tell me something horrible was wrong in order to lift the weight bearing down upon my heart. But as I knew only too well, life can be painfully mysterious, and prayers aren’t always answered.

I had seven hours of pre-op testing. They said they wanted to “dot all the Is and cross all the Ts” just in case something happened with my heart during the procedure. Over and over, until I couldn’t stand myself any longer, I was forced to tell the story to various medical staff of how, as the oblivious head of OB had said, I had “gotten myself into this situation.”

On the night before the termination, I lay in the bathtub, my eyes soaked as much as the rest of me, holding my belly, repeating the words, “I’m so sorry. Please forgive me”; another desperate yet futile prayer.

In the car the next morning, on the way to the hospital, that increasingly familiar yet preternatural silence set in. And then came the moment I had dreaded everyday since Aisle 7: when the anesthesiologist inserted the needle into my arm in order to sedate me and said, “Are you ready?” It was truly the worse experience of my life.

I awoke some time later in a bed slightly raised, with a plastic rail extended on one side. At my feet stood a chocolate-haired nurse tugging and tucking at the soft sheet that covered me.

“Water?” I blurted out, my words raspy as if trying to fight their way around cotton balls. Within seconds a Styrofoam cup was coming into my hands, and she helped me to sit up.

“How are you feeling?”

I still didn’t know. “Okay,” I finally whispered. She smiled warmly and refilled the cup.

“Do you want me to get your husband?

Not really. I didn’t feel like talking — to him or to anyone at that moment. “Maybe in a few minutes.”

Unfortunately, she did feel like talking — or, more to the point, she had a litany of post-op information and instructions that duty required she go through before I could be released.

“You’ll have some bleeding and spotting for a while…any significant pain or heavy flow you should call us immediately…could be signs of hemorrhaging…don’t worry, everything should soon return to normal.”

Normal? I no longer knew what that was. I nodded stupidly.

“Do you have any questions?”

Too many, but none that a human being can answer. I shook my head.

Her eyes found mine, and in them I could see curiosity. I also sensed a reluctance to ask me whatever was on her mind. Eventually, something got the better of her. “You’ve had quite a rough road for someone so young,” she said, scanning my chart. “Do you have heart disease in your family?”

I told her I didn’t.

“Genetic condition?”

“Nope.”

She looked stumped.

“The heart attacks were the result of some rare condition that no one seems to know a lot about.” It had become my standard line whenever people asked about the cause.

“And the pregnancy was…”

“Not planned, but apparently life-threatening.”

She smiled with an unexpected sense of empathy. And then she told me her story — one that was eerily similar and sadly comforting — about her sister who did die many years ago as a result of her pregnancy.

“She was young,” said the nurse. “The EMTs brought her to a Catholic-run hospital like she told them to. We were raised in the faith, and Saint Mary’s was the one our family had always gone to. Her husband begged the doctors to save her life when everything turned grave — which to them equated to killing the baby. So they waited and waited and waited, keeping her ‘comfortable,’ as one doctor called it, until ‘nature would take its course.’ In the end, they couldn’t save the child and more or less killed her.”

“A sin of omission you might say?”

She smiled knowingly. “Yes, you might.”

I then told her my story, from my study of world religion and ethics, to the day I went to the emergency room with chest pains and learned that a heart attack was tying to kill me, to standing on the Western Front of pregnancy tests in aisle seven, to how I, a non-aligned yet abiding agnostic or secular sacred, called the Roman Catholic Father H on my way back from the high-risk OB/GYN’s office that horrible day, and the interesting — I’d say profound — advise that he gave me: “You have to choose life.”

There are many ways to interpret his words, as I knew when he spoke them: life of the baby or fetus, life of the mother, maybe both, maybe something broader. There are those who would have a kneejerk response as to which one he was advocating, but here’s the thing — about him and ironically, at its core, the institution for which he belongs: more important than imposing some creedal moral dictate to someone struggling with indecision, such as I was, is reminding her that not only is “life is a gift,” but also that human beings have been “gifted” (i.e. possess) the freedom to act according to one’s own conscience and discernment. In other words, what did life mean to me? And, therefore, how would I choose to respond?

Like so many other women (and men) who want children, I would have loved nothing more than to see my pregnancy to term. But in some instances — more than any of us in such a situation would wish, and often at nature’s creation, not ours — this is not the life-giving, life-fulfilling response. It’s torture. It’s an end. It’s death, in one form or another.

When faced with impossible odds or an impossible situation — one that tugs on our heartstrings or brings us to our knees or makes us rail against the heavens while mired in hell — we, as human beings, sometimes have no other choice than to make impossible decisions. That we make them is not a flaw in our character, a failing of nerve, an easy way out, or a stain upon our soul; to the contrary.

I knew all along what had to be done, but when that conclusion is so counter to one’s own desires, it’s easy to indulge all manner of alternatives — even the irrational or fantastical ones. In the end, there was only one option: I had to choose life — the only one I could.

And I did.

Thank God — and by that I include thanks to the many individuals over the decades who value and have fought for “life” in all its complexities and variations —that I had that “choice.”

~

Michele is a writer, ethicist, and therapist. Her work has appeared in The Boston Globe, The Daily News, and The Basement Series publications, Partners HealthCare journal, Living Well magazine, and Be Well and Life Without Baby blogs. Her non-fiction books include Stirred Not Shaken and Spirit Wellness. Her upcoming novel, The Unfaced, won the 2015 Mystery Writers of America’s Helen McCloy Award for Mystery Writing. She’s lives in San Francisco with her 25-lb Maine Coon Cat Sebastian. She is represented by Kimberley Cameron.

You can find me at micheledemarco.com, and reach me at michele@micheledemarco.com.

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To learn more about SCAD or to find ways to raise awareness and promote research about this deadly disease, please visit: http://www.scadresearch.org/.