A happy face on a stick transforms me. My breasts become tender, fatigue overwhelms. It becomes part of my being. Growth sprouts into a grain of rice, a blueberry, and a raspberry with duck feet. By spring, a plum dangling from a tree branch—fingernails, toes, bone.

 I pee. Something’s wrong—I see bright red blood in the toilet bowl. I wash my hands under cold water, take a breath, and open the door. Nobody at the office knows I’m pregnant until this moment, twelve weeks in. I’m driven to Emergency.

"Rest and take it easy until the spotting stops. Don’t have sexual relations until then. If the spotting gets worse or if you start bleeding, go to the hospital.” Dr. M.’s advice echoes through my mind during the car ride.

Six weeks earlier I had an early ultrasound at the six-week mark on the recommendation of my family doctor because spotting can be a warning sign for possible miscarriage. I’m thirty-eight years old, found my life partner past peak fertility years, and became pregnant within the first year of our relationship.

I lay anxiously on the bed in the ultrasound technician’s office, my tummy bursting from drinking the required liter of water to fill my bladder. Cold, thick jelly is rubbed onto my belly before the UT places a handheld probe onto my skin; she analyzes the screen. My partner sits on a chair beside me.

“At this early stage, it’s difficult to see the fetus. Drain your bladder so we can conduct a pelvic ultrasound,” she advises. The UT places an oversized condom over a white phallic-shaped wand attached to the ultrasound machine. She instructs me to insert the wand into my vagina and we watch the monitor.

The image springs to life. The age of the fetus is approximately six weeks determined by its size—equivalent to a “grain of rice.” We see the heartbeat pulsate on the screen. I giggle. My partner raises his eyebrows, grins, and for the first time, the pregnancy feels real to us. We nickname our cluster of cells, “Rice.”

Now, my coworker drops me off at Vancouver General Hospital Emergency shy of five p.m. I walk through the automatic doors, my face wet with tears, afraid, alone. My partner is out of town on a business trip.

A twenty-something platinum blonde ER doctor is the first person to attend to me after a forty-five-minute wait. Upon completion of examination, she says, “Your cervix is closed, which could mean the fetus is okay, or it could mean a miscarriage has already taken place.”

Thirty minutes later, a Filipino nurse enters and draws six vials of blood from my arm. “Nice Sketchers,” she says, glancing at my shoes. “Where did you get them?” 

Ninety minutes later, a European man two decades older than the blonde arrives with the blood test results. "Hello, I’m Dr. J. There is a pregnancy hormone called HCG that is present in pregnant women. Your blood work shows that your level is only 423, which at this stage is unusually low. At three months, it should be well into the thousands. It’s likely that you’ve had a miscarriage. I’m sorry. Here’s a “fast track” form for you. The ultrasound department will call you tomorrow to book an ultrasound. This will confirm the result.”

I cry, walk home alone, and pray for a heartbeat. The next day, I repeat the same procedure for my second ultrasound.

The UT asks, “Are you sure about the dates? You’re twelve weeks?” 

“I’m sure.”

“Okay. We’re finished here. I’m going to write up a report and walk you to Emergency where I need you to check in and give them the result.” Once she finishes writing my report, she hands me a white envelope. We walk together in silence. I hang on to hope that the envelope will bear good news.

A balding Chinese ER doctor arrives and sits beside me on the patient bed. “I’m Dr. C., the emergency doctor. I’m so sorry to say, the fetus stopped developing. The heart stopped beating.” This is the result I’ve been fighting against, praying for the opposite. I cry unbridled for several minutes. At my request he reads the ultrasound report to me once I calm down.

“Fetus size approximately eight weeks, four days. No fetal heartbeat found.” He squeezes my hand, offers a tissue. He advises that there will be some bleeding for the next couple of weeks, explains the miscarriage process. It can’t be true. I saw the heart beating at my six-week ultrasound.

“How…why?” I ask.

“Twenty-five percent of pregnancies end up in miscarriage. There is no reason for this. There’s nothing you could have done to prevent this, and nothing you did made this happen,” Dr. C. explains before handing me a “Medical Fact Sheet about Miscarriages.”

“The heart stopped beating. The heart stopped beating.” These are the words that make an impact. I blame myself. Did I exercise too often or too hard? I’m mad at myself for not stopping sexual intercourse when I found out I was pregnant. Maybe sex provoked the bleeding. Did my anxiety about worrying constantly about the risk of miscarriage stress out the fetus and cause the miscarriage? Fuck, I don’t know. I read the fact sheet.

 Most miscarriages happen because the fertilized egg in the uterus doesn’t develop normally. A miscarriage is not caused by stress, moderate exercise, or sex. In many cases, doctors don’t know what causes the miscarriage. The risk of miscarriage is lower after the first twelve weeks of pregnancy.

I leave VGH and walk home alone, wishing my partner was in town. I purchase a bottle of extra strength Tylenol and a thirty-six-pack of super absorbent maxi-pads, per the doctor’s instructions.

The following Wednesday, I visit my OB for the second time. Dr. M. examines my uterus, tells me there is still tissue. I suffered a “missed miscarriage.” He explains, “This happens when embryonic death has occurred but there is not any expulsion of the embryo. It’s unknown why this happens. Signs of this would be a loss of pregnancy symptoms and the absence of fetal heart tones as found on your ultrasound.”

“The absence of fetal heart tones” a.k.a. “no fetal heartbeat found” a.k.a. “the heart stopped beating.” This is what I hear.

He scribbles a prescription for eight misoprostol tablets that are to be inserted into the vagina to induce bleeding and cramping to expel the pregnancy. “Take the first four tablets and take the remaining four if necessary.” I chose this option because I want to expedite the miscarriage. I dread the thought of what I imagined would be more distressful: the process of waiting several weeks for the miscarriage to end on its own, naturally.

“In the meantime, don’t use tampons. Get plenty of rest and avoid vaginal intercourse until the bleeding has stopped. It may take time for your cycle to normalize, typically four to eight weeks. This period may be heavier than normal. Call if the bleeding lasts more than two weeks, gets worse, or if you develop a fever or have foul smelling vaginal discharge, which could be a sign of infection.” The doctor’s voice sounds automated. I sense he’s anxious to see the next patient sitting in the crowded waiting room.

 “When can I try again?”

“It’s best to wait at least two regular menstrual periods before you try again. If you try before then, the chances of having another miscarriage are much higher.”

 I insert four tablets into my vagina Wednesday night. My vagina and anus swell up as if massive wooden tampons were shoved up both of my private holes. The cramping starts at midnight. It hurts like hell. Pain-inducing thumping pulsations coupled with razors slicing my guts as I lie in bed next to my snoring husband. How the fuck can you sleep through this when I’m hurting?

I tell my partner the next morning, “I spent most of the night running to and from the toilet and stained four maxi pads with bright red blood within a few hours. I crapped every time I went to the toilet, a nasty side effect of pills designed to cure ulcers. Fucking ulcers—I stuck heartburn pills up my vagina.” He shrugs, embraces me, and tells me he needs to leave for work. There is nothing he can do.

I don’t know if I passed all the tissue and fetal matter, but I decide against taking the remaining four pills. I’m not reliving hell a second night. The pain continues for the next twenty-four hours. On Saturday afternoon the constant throbbing in my lower back, abdomen, and anus leave me exhausted, melancholy, empty. My breasts are still tender, full. I place my hand onto my tummy.  

I need fresh air. When I walk down Broadway it seems every woman I encounter is pregnant; the chatty owner of the corner store, the girl in the queue at Starbucks, the vibrant woman boarding the B-line. I stare at their proud, swollen bellies, envious. Why do those women deserve to be blossoming with healthy pregnancies, and I don’t? Am I being punished? Fuck. I toss my coffee into the bin, go home, and cry.

I dream that I’m pushing an old-fashioned carriage and a woman asks to see my baby. I check on my sleeping infant and panic when I see he’s gone. I lift off the blanket and discover a heart the size of a raspberry, pumping.

 The following Tuesday the final ultrasound reveals all tissue has passed. There are no traces of the “products of conception.” After searching “miscarriage” online multiple times, I realize some answers make sense, but it doesn’t make me feel better. I experience a series of hormonal mood swings, intermittent minor bleeding over the next couple weeks, and mild depression. The moment I wake up my head throbs. I don’t eat. I’m exhausted and cry every day. I want to go back to bed.

Nobody talks about miscarriages. I open up, share my experience with other women, people I feel safe with hoping it’ll help me cope, heal by admitting it happened. Over a dozen women I spoke to suffered miscarriages. Every woman copes with grief of early pregnancy loss in her own way. I discover through our conversations that intimate stories of our losses bond women together.

 A colleague suffered six miscarriages, was finally diagnosed with Antiphospholipid Antibody Syndrome (APS), a disorder of coagulation which causes blood clots and pregnancy-related complications. A friend delivered her baby at almost forty weeks although it died in her womb before she had a chance to take her first breath. My mother confided in me about her own miscarriage after I told her about mine. We cry together, my colleague, my friend, and my mother.

 My optimism is revived knowing many of the women eventually delivered healthy babies. Others are waiting, wondering if and when they’ll do the same. I accept that miscarriages happen and, like many life occurrences, they’re beyond my control. I focus on being grateful for my own health and life partner. We’ve taken time to discuss our feelings and emotions about the miscarriage. While my partner never cried about our misfortune, showed little emotion or empathy towards how much a woman can suffer through a pregnancy loss, he revealed his own sadness—the chance lost between us. My anxiety wonders if he’ll leave me if I can never birth a healthy baby.

“Being with you is what matters most to me,” he reassures me as we lie in bed.

“I’m so sorry I lost the baby,” I say.

“No, please—it’s not your fault. There’s nothing you did to make this happen and nothing you could’ve done to stop it. I love you more than anything and anyone in this world, no matter what. And thank you,” he pauses. “Thank you for carrying our little fella for almost three months.” He places his hand onto my belly, I place my own over his, and we say goodbye.

-Mary Chang

After a painful second miscarriage, the author had a healthy baby boy via emergency C-section at the age of fourty. Mary Chang is an award-winning short story fiction writer, published magazine memoir writer, and freelance writer. She lives with her lifetime partner in British Columbia, Canada, with their quiet, creative, curious son. When she’s not writing stories, she makes time for personal fitness challenges, chocolate cake, adventures with her son, and exploring the the West Coast. Read her writing at: www.marychangstorywriter.com.