Finding Peace Through Recurrent Loss

Abstract

Finding Peace Through Recurrent Loss L. Emily Cotter I had never felt exhausted on so many levels—emotionally, physically, and professionally. It was a year and a half into the Covid pandemic, [End Page 209] and I had been working as a palliative care physician bearing witness to unspeakable suffering and loss. With the more widespread availability of Covid vaccines, my partner and I decided we were ready to try to have another child. Now we were experiencing our second consecutive miscarriage, and the grief felt immense: my uterus cramping and emptied, my heart shocked and devastated, my mind wearied and numb. It had taken us more than a year to conceive our first child, a young girl who brightened our lives with her smile and infectious joy. Born a few months before the pandemic began, we raised her in an environment we had not envisioned nor hoped for her. Despite what felt like a non-traditional childhood experience, seeing her blossom into a thoughtful human being excited us to think of her one day becoming a big sibling to help love and care for a younger one. After our first positive pregnancy test, I tried to protect my heart, knowing the prevalence of miscarriages and risks we were facing. No attempt at building defenses could shield from the uncertainty that crept in when the first ultrasound showed a length shorter than expected without convincing cardiac activity. Adding insult to injury, I was sent for a formal (and quite expensive) ultrasound to confirm what my heart knew, and then I waited for another clinic referral to discuss options for miscarriage management. I recall only a melancholy joy getting pregnant a few months later—the hope and excitement overtaken by anticipation of recurrent heartbreak. This time, cardiac activity on our first ultrasound provided an opening for optimism, although the embryo was again measuring slightly smaller than expected. Trying to put these thoughts out of my head, I continued to live life in the best way I could: being a mother to our toddler and in service as a physician. I focused my energy on a gratitude practice, thankful for my health and the ability to try to become a mother again. Spotting then appeared and intensified, and once again my heart knew this was not meant to be. While the second miscarriage ended spontaneously, the experience with follow up medical care felt worse than the first. Fellow clinicians provided unsubstantiated and non-evidence based medical advice about waiting for multiple cycles prior to trying again, despite my age and likely dwindling ovarian reserve. Anger crept in for other patients who would not be able to easily fact-check this falsehood and potentially lose precious time if they, like me, were later in their fertility years. Multiple physicians and nurses projected emotions misaligned with my own, frequently entering the room with a version of "you must be [worried/anxious/ nervous]" without an attempt to understand my lived experience. Flippant comments referenced a presumed stress level with an insinuation this was a reason for my pregnancy losses. (While I acknowledge imperfections, I thought I was maintaining a decently well-balanced life raising a thriving toddler despite working as a palliative care provider amid a global pandemic.) I felt disillusioned leaving these medical appointments, embarrassed for my own profession, and alone without medical providers who I could trust to guide me. I had been candid with friends and loved ones discussing life after our first miscarriage, hoping to break the trend of carrying these losses silently. After the second miscarriage, I found it more difficult to invite people in. I could tell close friends that it occurred, but I didn't feel ready to grieve openly. I created distance from people who might ask about my pregnancy while simultaneously feeling abandoned by my own body. It seemed my body had failed, with a cruel twist of irony that after a year of struggling to conceive our daughter, here we were, spontaneously getting pregnant yet not making it past the first trimester. I wanted space to grieve alone but didn't know how to unpack these feelings in moments of protected time when not at...