The Expert

When I last wrote, I was in the throes of panic, worried that I had somehow caused my latest miscarriage by having a D&C -- or worse! -- rendered myself infertile. I pieced together enough internet fodder to fuel the fires of that fixation and, when I discovered that one of the world experts for dealing with consequences of D&C scarring works right here in the Boston area, I called his office, poured out my list of worries, and made an appointment.

When I cooled down a bit, I read all those scary articles a little closer and realized that I do not have any of the major symptoms of Asherman's Syndrome beyond multiple miscarriages. I felt silly and thought about calling to cancel my appointment.

"Keep it." Said Hub. "If it really was stupid to make this appointment, the nurse wouldn't have asked you to book it."

"Keep it." Said my friend. "It will set your mind at ease."

That is how, this morning, bright and early, I found myself in the waiting room of Minimally Invasive Gynecological Surgery -- a very different kind of GYN office than I am used to. Instead of the piles of magazines full of glossy pictures of beautiful children and scads of terrible parenting advice, there was only a single book on the coffee table: Surviving Infertility.

I hesitated over the box that gave permission for med students to take part in my care. I am uncomfortable with the idea. I know a too many med students to trust their care, but love enough of them to feel guilty saying, "Practice on someone else." I ticked my permission and introduced to Dr. 1 and Dr. 2, both conspicuously my junior. Like most of my previous experiences with med students, they devoted a lot of attention to checking lists, not wanting to forget anything important.

Dr. I, the high-profile expert, is quiet and kind. He recommended a pelvic ultrasound -- the one where they put the scope in your vagina, and move it around as though you were a gear shift. The two students had the honors. Dr. I was there too, and an ultrasound technician. One of the perky young students drove, clumsily, and everyone stared intently at the screen. I watched Dr. I. My heart skipped a beat as grimaces flickered across his face. Something must be wrong.

And it was, but not with me. He was fighting the urge to intercept the wand and manipulate it more efficiently and gently himself. He succumbed, just for a moment, then, once more, forfeited the helm to the younger doctor.

"You look good." Dr. I briefed me. "No fibroids. Your ovaries are great. 8 mm thick lining, so we can't do a scope and look for scarring today. Call on the first day of your next period and schedule that appointment." He was cautious, but reassuring. "I expect to find that it is fine, but won't know until then."

I felt relieved. I felt like a drama queen. He looked as though he was preparing to leave, so I swallowed hard and asked the one question I came prepared to ask of the world expert in cleaning up the ravages of D&Cs gone wrong.

"You know," I started, and all eyes were on me, lying on the table under that stupid paper blanket, legs in stirrups, the human joystick "I agonized over the D&C. I waited a month to miscarry naturally, but I didn't, and waiting was just too hard. It drove me crazy. Eventually I had the D&C for my mental health. But then, with the next miscarriage, it brought back all that worry, and I just wanted to ask: when should a woman have a D&C, and when should she not?"

"You didn't do anything wrong." He said. "A D&C was a reasonable and good thing to do at that point. In the first trimester, the chances of getting scarring are low, under 3%. In later term D&Cs and post-childbirth D&Cs that the risk is much higher, 40%. But yours was early and not risky. It was a good choice."

I have counseled other women about their miscarriages in the past months. They're always worried, "Was it that coffee I drank? That glass of wine? That time I went for a run? Or had sex? Or fell down? Or that I cried with fear when I saw my two lines? Did I just not want it badly enough?"

I tell them, "No. No no no! You know in your heart that you would have done anything for a healthy baby. When we lose something, we want to be able to explain it away. We want to place blame, even if it means placing it on ourselves. But sometimes there's no blame to be placed, no sense to be made. Sometimes things just happen. And it's not your fault. You did nothing to make this happen. It was just bad luck."

That is what I needed to hear from Dr. I, and that is just what he told me.