It seems that the heart is bigger than the womb, by my reckoning. The womb starts out smaller than the heart at least, flat and triangular when it’s empty. I believe most people think of it as a large hollow thing, like a chamber, which will surround a baby like a bubble or a balloon. But the womb is dark and sticky and its contractions on itself are what staunch our bleeding. It’s more diminuitive than a pear or a lemon even and has much less volume. The heart is larger than the womb and more complicated.  

In Chinese medicine, the Bao Mai is the channel running between heart and womb in women. The highway between desire and manifestation, the vertical axis from grief to letting go, the internal marriage of fire and water. For women, there are the everyday losses, a waxing and waning moon, a filled and emptied out heart, an unfertilized egg exiting us like a small unimagined future. The fertilized ones also leave us barely past implantation, so that we don’t even know that a blastocyst was there, with cells gone awry at day 5 or 6 or 7 of embryonic development. The bigger losses rip our insides out and the tentacles of these reach up the bao mai to entwine themselves around our hearts, the threads of motherhood already weaving their way into our subconscious, the barely perceptible heartbeats the stuff of our dreams.

We may only have a ghostly gray-white image from an ultrasound, printed on shiny photo paper, our name and date on it the only evidence of motherhood.  These were hard for me to see once, when my happy patients brought them in for me over and over, sometimes in envelopes and once proudly displayed in a frame. I came across my ultrasound picture just the other day. December 21, 2005. 9 weeks and 5 days gestation, measuring 2.3 centimeters. Measuring off by a couple of weeks at least. Heartbeat detected but no doubt too slow, indicating a doomed attempt at circulation, indicating a likely chromosomal misalignment, maybe trisomy 16, which is most common, maybe 21. Even though the nurse neglected to tell me that the baby was too small for my dates and likely had a sluggish heart rate, she didn’t.

But my heart knew what my womb didn’t. The fetal demise probably happened around the end of the 9^th week, but I would carry that baby until 12 weeks. But I dreamed of pushing a baby carriage into a driveway a few nights before the bleeding started. I dreamed that I gave a baby to two women who pushed it onward without me, I dreamed of knowing the baby was going to be safe. My dog, Milo was with me and acting up on his leash as usual. We left the baby with the women and we walked on.

When mild cramps started at 12 weeks, I thought they were normal at first. I felt them all day at the office and asked my doula client if they were normal. They built as I sat through my friend’s mom’s reading at the Tattered Cover bookstore that night. I was looking at a Mary Ellen Mark photography book when they became too intense to ignore, when the pain started to steal my breath bit by bit. I told Greg we needed to go. I remember being on Josephine street, driving by the Botanic Gardens, my feet up on the dashboard as Greg drove us home. I remember calling my old friend Diane in San Francisco when we got home. She had had a miscarriage and said she also didn’t bleed right away either. Maybe I was just cramping and it would be OK.  I remember calling my sister Becky, the OBGYN, to see what I should do. I drank water, like they always say, and took a bath.

At some point around 11 PM I walked through the threshold that lies between worry and resignation and knew I was losing this baby. In moments like this, I fold inward. I could barely look at Greg by then and could only repeat “why is this happening to me” over and over, as if there was an explanation. As if understanding it would make it better. I later integrated this gradual loss of control in my body as a valuable practicing for death. Something was happening inside my body that was beyond my control. Something precious was slipping away and I couldn’t stop it. To stop this small death in life would be like stopping a tidal wave with a teaspoon.

             In immediate need of animal comfort, I knelt on my old zabuton-turned-dog bed and rested my forehead on Milo’s forehead, girl to dog, like when I was a lonely kid in a big house where there was always at least one equally lonely dog to soothe me. My crazy, poorly trained bird and possible pitbull mix, the one who had accompanied me to six houses in seven years, who had a feral streak that blossomed in the marshes of Georgia where he took down raccoons and rabbits and even what we believe was either a small gator or a badger once. Who fought to the death with whatever that loud hissing animal was until his throat was riddled with puncture wounds and filled with a grapefruit sized pool of blood. Milo, who slept in my bed and under the covers, until Greg came on the scene and kicked him out. Shiny, black short-haired Milo, long-legged beauty with the spotted belly of a dalmation. One of a kind and impossible to walk. Leash aggressive and happiest in the mountains, a dog who almost drowned himself chasing a pelican out to sea. A dog who stayed upright on all fours in a canoe in the surf of little tybee island when Greg and I both went overboard. A dog who was my first baby really, when I should have been old enough to be a good parent, but made crazy choices for the both of us.

As I lay down against Milo’s body, something deep inside me popped like a soggy cork and I knew my water had broken. When I stood up, the blood and fluid that gushed out of me drained my face of its color. Greg fell to his knees, grabbed my ankles, and let out a guttural howl I had never heard from him before. I was frozen in that spot and didn’t dare move my head, saying, “I don’t want to see it, I don’t want to see it.” He wiped up the floor and gave me a thick black dishtowel to soak up the blood that was coming in waves with each contraction.

When I called my OBGYB sister, she said we’d have to go to the ER since I was so far along. We drove the few blocks to St. Joe’s hospital and passed the sign for the L&D entrance, circling around to the emergency room parking lot. As we got to the back of the hospital, I had the dreaded thought that maybe I had bad eggs, even though I was barely 36. In my fertility acupuncture practice, I’d seen other women younger than me with fertility issues and recurrent losses. I didn’t want to be one of them. I had conceived on my first try. I had even put an exclamation point in the relevant section on my pregnancy intake form a few weeks before. I believe it was the part that asked, “how many pregnancies have you had?” and I wrote, “one- pregnant on my first try!” like I was somehow above average even in this regard.

It was dark and empty in the ER lobby. There were lots of potted plants and empty tables and just a couple of other people there since it was past midnight. We waited in silence until the admin brought me to the ante-room where she took my blood pressure and remarked how calm I seemed for what was going on. It’s times like these that my mother’s main admonition to me growing up, which was “be stable, be stable” and my protestant stoicism served me, at least on the outside.

I don’t think I said much back to the intake lady and waited several more minutes, the dish towel getting heavier and heavier as I continued to bleed. Finally, after at least 45 minutes, they decided to bring me back and made me sit in a wheelchair to take me down the hallway to the examination rooms. We were left in a room and I curled into child’s pose on my knees as the contractions overwhelmed me on the white cot. When a nurse came in, Greg said, “she was 12 weeks pregnant.” The nurse replied, without even a hint of empathy, “well, is she 12 weeks pregnant or was she 12 weeks pregnant.” I go into a black hole of forgetting here and know I was curled up and not looking at her but I think I said, I’m having a miscarriage. I was still a serious Vajrayana Buddhist practitioner at the time and the teachings kicked in, for better or worse, as I prayed that the karma of all sentient beings ripen upon me through this suffering. The logic of it goes something like this: since I’m enduring such intense suffering right now, I may as well bear the burden of all sentient beings’ bad karma while I’m at it, so at least I’ll come out of this with some merit.

When the ER doctor finally came in, he opened with, “are you doing Lamaze classes? My wife I did the Lamaze classes.” I was taken so off guard by this that I started to say, “ I was thinking of doing the Bradley method classes” but just trailed off.  I really had to pee at one point and went down the hall to the bathroom around the corner. Plum-sized clots were dropping out of me into the toilet by now. It didn’t feel right to potentially flush a fetus down the toilet, so I let the nurses at the counter know as I went back into my exam room. A few minutes later, I heard them joking about who on that shift would have to fish out the contents of the toilet bowl.

Wheeled to another room where there was a transvaginal ultrasound machine, we were able to confirm that the pregnancy was no longer viable. The ER doctor actually drew a uterus and cervix on the sheet of the cot by way of explanation, letting me know that when the cervix opens too early and the fetus comes out, that the baby can’t live. I thought to myself, “No shit, Sherlock,” and “FYI, I know my female anatomy, douche bag.” I’m pretty sure the poor guy suffered from Asberger’s.

When Dr. Warner, the Kaiser OBGYN, finally came in, she was the first person who seemed to realize what was happening. She looked me in the eyes and took my hand. I finally had permission to cry. Just before she examined me, I had the feeling that people describe as part of labor: the overwhelming need to defecate. I went to the bathroom, this time with a yellow colander-like basket to catch any tissue, and pushed. When I came back, she examined me and said that indeed the tissue was coming out and she used a hemostat to extract it the rest of the way.  It felt like she had sharp things way up inside my uterus at one point and I wondered if I was having an unmedicated D&C, which is how it felt. I was too spent to argue about having the tissue karyotyped knew Kaiser wouldn’t want to pay for any testing since this was my first miscarriage. A robotic nurse, whose kids’ photos were added to the ID badge on her lanyard gave me some handouts on choices about where the fetal tissue would go if we didn’t wish to have it buried. I think we signed off that it should go into a group cremation. I’m not really sure. She also gave me some handouts on loss and told me to take Advil when I got home.  I was still being racked by intense contractions and I said I didn’t even have Advil, so they gave me a few Vicodin, two of which barely took the edge off.

I don’t remember the car ride home. I don’t remember showering. I don’t remember much besides feeling emptied out, hollow, like a shell of the hopeful person I had been the day before.  Like I had been sucker punched from the inside out. Like I didn’t want to face waking up again that empty. Like it had maybe all been a dream. I sometimes wish I had made Greg look at that baby, just to know it was real. I do have the ultrasound photos, but I wish one of us could have witnessed this being in all its dimensions. I was afraid I’d be haunted by its tiny hands, or skull, or eye sockets. I’ve had clients who have thoroughly examined their fetal tissue during miscarriages and others who have held stillborn babies for hours, photographing them and documenting their existence. Naming them and giving their grief a shape to latch onto. I, however, rapidly began a process of shutting down, of a letting go just this side of total denial. I didn’t speak of him or her as a baby ever again. I spoke of a pregnancy, but no fetus. Just like the mild opiates could numb my physical pain, I would use semantics to wrap up this loss in layers of wordy deception. There was never a baby, just a pregnancy. What I didn’t see couldn’t haunt me.