Pseudo sac, pouch of Douglas, foetal pole – a fresh batch of medical phrases I picked up in hospital on Thursday.
If nothing else in IVF1, my vocabulary is growing.
The day starts well
My friend Jessie visits. We met at university sixteen years ago. Somehow we managed to get degrees, despite our commitment to the pub over the road. Jessie has been through so much with pregnancy, including miscarriage, stillbirth and successful pregnancies. Thank God for friends with experience. There is no awkwardness when I tell her my news.
Jessie tells me about having no pregnancy symptoms with her two kids. She tells me about having an early scan with her daughter, where the doctor wrongly diagnosed an incomplete miscarriage. We talk about the loss of her son and how difficult people find it if she mentions him. We also speak about her two teenage kids – who were a tot and a pregnancy bump when our friendship first started.
We head out for lunch. We order juice and healthy-sounding burgers. We pick up our conversation with the plot leaps in friends’ lives, since we last met up.
Suddenly, I have an intense cramp, so strong that I feel sick. I try to stay with the conversation. There is that daft British instinct not to make a fuss (stupid habit!) but then comes the heaviest bleeding yet.
Thankfully, common sense returns. I tell Jessie what is happening. She understands, immediately. We make our apologies to the café staff and head home.
Game shows and new words
Dad 100 and I drive to hospital. We go straight to the Early Pregnancy Assessment Unit. A sleepy lady on reception gives me a clipboard with a form to fill out.
During our afternoon in hospital, we discover that Channel 4 afternoon telly is the same as thirty years ago – Fifteen to One and Countdown – except both shows have different hosts now. The presenters I grew up watching are now retired (William G Stewart) and dead (Richard Whiteley). I laugh at the swift reminder of my age.
Within ten minutes, we see a nurse who takes brief details. Back to the waiting room for more quiz questions – I get one right about the Pixar movie, Inside Out (great film) – then we are called for a scan.
The sonographer is an Irish man called Robert. I ask him to show me what he can see on the screen. He shows me my right ovary, normal he says. I look at the grey ball with black follicles, an asteroid in space. Then we whizz over to my left ovary – abnormal, he says, due to an endometriomal cyst. Old news, Robert, old news.
Robert says there is fluid in my pouch of Douglas – er, sorry? my pouch of whom exactly? It turns out there’s a cavity between my uterus and rectum, named after a Scottish anatomist called Dr James Douglas. The good doctor explored this area of female anatomy in the early 18th century. He then named body parts he discovered after himself, including said pouch!
A jellyfish head
Then Robert shows me my uterus. The consulting room suddenly feels wide open, roofless. Time stops for at least twelve heartbeats. Robert points the device at the top of my uterus. He shows me what looks like a jellyfish head – a floaty ghostlike appearance.
“It looks like a small gestational sac,” Robert says.
“Oh, really?” I say.
Dad 100 and I peer at the screen, hopeful, a bit tearful.
“But I can’t see anything inside it,” Robert says. “There’s no foetal pole or yolk sac, so it may be a pseudo sac.”
A pseudo what?
When I am dressed, I ask Robert to explain further. He is perching on the clinical waste bin by the door, however – he’s a scan and run kind of guy.
“Take a seat in the waiting room,” he says. “The doctor will call you soon.”
Cue the purple plastic chairs and the theme tune for Countdown. Dad 100 and I lose ourselves in the letters and numbers games. I get a 7 letter word – PLASTER. I award myself an extra mark for the relevance to our location.
The doctor calls
Nargis is her name. She is friendly with a round face, around fifty years old. I am reassured by her slightly messy hair. In the consulting room, Nargis invites us to take a seat.
I peer at Robert’s report on her desk, while Nargis types up notes. Have you ever tried reading medical words upside down? It’s a skill, I tell you, to cross your eyes in exactly the right way, whilst trying not to be caught out.
I learn from my snooping that I’m 6 weeks pregnant. The expected delivery date is 26th January 2017, tucked between my birthday on 16th January and Dad 100’s birthday on 4th February.
I see Robert’s report of the 2mm gestational sac and I feel that wide-open-stand-still feeling.
Then comes Robert’s diagnosis: “incomplete miscarriage.”
Okay, I’ll stop reading now.
“There is always a chance”
“So, what is happening actually?” Nargis says. She has an uplifting smile.
“No idea,” I say.
“We have seen a very tiny sac. It could be a pseudo sac or it could be a pregnancy sac. At this moment, we are not sure.”
“So, there is still a chance that there’s something in there?”
“Might be, I don’t know, but the pregnancy hormone level suggests that it could be an incomplete miscarriage or ectopic. We have not seen any foetal pole. No yolk sac.”
Nargis takes time with us. She asks questions about the level of bleeding and pain. She doesn’t rush us, which is the best gift any doctor can give. We can think and breathe and ask questions. Nargis takes some more blood from my arm, to test beta-HCG levels and iron.
“We will do another scan on Tuesday and we will test your hormone levels again,” Nargis says. “Then we will discuss what management we will do.”
“Is there still a possibility of things working out?” Dad 100 asks.
“I am not sure at the moment. There might be. There is a sac. To see something inside, the hormone level should be around 1000.”
I ask Nargis about other explanations for the sac. Do they sometimes form without anything in them? She says it could be that – a pseudo sac – an impression that I am pregnant. Sometimes the uterus will do that, apparently, in response to a pregnancy of unknown location. It can also mean an incomplete miscarriage. She says the fluid in my pouch of Douglas may have come from the gestational sac.
“In your experience, Nargis, are there ever cases with this amount of bleeding, where things work out?”
She smiles, takes a breath.
“Be truthful, it’s okay,” I say.
“It could be a miscarriage. I don’t want to give you false hope. But there is always a chance. So please carry on with the progesterone and oestrogen until Tuesday.”
There it is again – a faraway star called hope, twinkling constantly.
Omelettes and psychics
At 4.15pm, Dad 100 and I finally get some lunch in our favourite caff near the hospital. Spanish omelette, chips and peas. Oh, the relief of food. We both feel calmer with grub to demolish over a debrief session.
We agree – we have not yet heard conclusive proof that it’s over. There is the possibility that it was too early to see anything in the sac. I tell Dad 100 about Jessie’s story of her early scan and the wrong diagnosis of incomplete miscarriage. How we reach for hopeful stories at these times. We devour our food like hungry bears and head up to the counter to pay.
A woman calls out to me from across the café.
“I like your shoes,” she says.
She has wild dark hair. She is wearing clothes that could either be pyjamas or comfy casuals. She fixes her eyes on me.
“I am psychic,” she says.
I’m always intrigued by strange characters, so I stop for a chat.
“What’s your name?” I say.
“Sybil. Do you have an education, a husband?”
I say yes for simplicity, although Dad 100 and I are far too lazy bones to organise a wedding.
“Ask me something,” she says.
“Okay, why not? What do you think will happen next Tuesday?”
“It may go up, it may go down,” Sybil says. “But really, the most important thing is balance.”
Sybil then says something about taking care of my heart, which I don’t quite catch. Her parting line is this, “you need to believe in something.”
“Thanks Sybil, that’s good advice.”
“Thank you for talking to me,” she says. “I am staying in the hospital. You can come and visit me there, if you like.”
Outside the caff, it makes us smile. That we still have hope, despite all the odds. That we still believe there may be miraculous news, possibly even delivered by Sybil the psychic!
It’s great to find out that hope is stronger than fear.