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Dr. Truth Jekyl and Mr. Hyde Denial

We both began bleeding on the same day.

I woke to it slowly. Drifting out of a deep sleep, I lay in bed, my eyes closed, inhaling the cool morning air that wafted in through the open window, its breath a welcome respite from the previous night's August heat. I stretched my body and sighed contentedly. Claude stirred beside me. I heard the footfalls of an early morning jogger pass below, on the street side of the house. A car drove by. I opened my eyes. Our bedroom was gray and still.

As I rolled onto my side, I felt a sticky warmth between my legs. Instantly, I was awake. I slid one thigh across the other and felt a sucking sensation as they parted. Clamping my legs together, I closed my eyes and willed myself to be dreaming. Everything was quiet, except for the thud of my heart in my chest. I heard another car drive by; then another. I opened my eyes again, this time more slowly. The first light was beginning to sharpen the outlines of objects in the room.

I ran my hand across my abdomen. Its slightly rounded fullness reassured me. After all, only yesterday the tiny form of the baby inside had appeared on my doctor's ultrasound screen, filling the room with the pulsing whoosh of its amplified heartbeat. Claude had smiled and squeezed my hand. My whole body had softened with relief. I had miscarried three other pregnancies before this one, all in their eighth week. Yesterday's ultrasound was the confirmation we had been waiting for; this baby, our third child, would be born in March. Will, our son, was five, while Hannah, our daughter, was nearly three.

Last night, I had stood in the nursery, running my hand over the rail of the empty crib, imagining the smell of baby powder in the air again. I slept more deeply than I had in weeks.

Now I lay next to Claude, hyperventilating between wanting to know and not wanting to know. Finally, I slipped out of bed, careful not to brush my thighs against the sheets. When I stood up, I felt a warm trickle run down my leg. I caught the tiny bead on the tip of my finger: blood. I cupped a hand over myself to keep from staining the carpet and tiptoed to the bathroom. Just then, I heard Hannah calling from her bed downstairs.

"Mommy, I have to go potty!"

I grabbed a wad of toilet tissue, wiped my thighs, and glanced at my image in the mirror. My eyes looked wild. I splashed cold water on my face and made my way to Hannah's room. I hardly noticed her sweetness nuzzling the nape of my neck as I carried her to the toilet. I was wondering how I could bear to tell Claude or anyone else about another miscarriage. I felt deeply ashamed; losing this baby meant I had failed again.

When Hannah was finished, I lifted her off the toilet seat and was catapulted out of my grief. Hannah's urine was deep pink: blood. Miscarriages I knew; blood in the urine of a two-year-old I didn't. For an instant, I couldn't think or move. Then a thickness seemed to envelop me; I felt numb but strangely efficient. Everything was happening, but I felt disconnected from any feeling in it. I heard Claude in the bathroom upstairs, running the shower. I dressed Hannah and myself, woke Will, set the table for breakfast and made three phone calls; one to my doctor, one to the pediatrician, and one to my friend Lili. When Claude came downstairs, I told him about the blood, Hannah's and mine. I couldn't even cry. Claude bent over the table, as though he was going to get sick. For thirty seconds, neither of us spoke. Finally he stood up and reached for my hand.

"Honey, what do you want me to do?" he asked. What he was really asking was if I wanted him to miss another day of work. For months, he and the other members of his engineering team had been pushed to the limit, their project overdue and over budget. Three weeks earlier, Claude's boss had demanded that we postpone our family vacation. Claude had refused, explaining that his family was more important than his work. Yesterday he had made the same choice by coming to my appointment with the obstetrician.

"It's okay," I said, taking a deep breath and swallowing my fear. "I've already arranged for Lili to watch the kids while I go to my appointment, and she's agreed to stay with Will while I take Hannah to hers. We'll be okay. I'll call you as soon as I know anything."

"Are you sure?" Claude asked.

"Definitely," I said, kissing him lightly on the cheek. "Really, it's probably nothing. I'm sure it's going to be fine."

Even as I said it, another part of me watched in silence, knowing what I said wasn't true. It was like being two different characters in the same scene of a movie. In the scene, Hannah and I were bleeding. One part of me felt quiet, accepting of this truth. The other, incapacitated by fear, needed to believe, if only for a while, that everything was going to be okay. I did the only thing I could do: I let both be true.

Silent Comfort

An hour and a half later, my obstetrician confirmed what I already knew: The baby inside me was dead. There was nothing but silence in the dark room as she glided the ultrasound wand over my belly; the tiny form that yesterday had a heartbeat and a birthday was nothing but a blot on the blue screen now. Tears pooled in my ears and soaked through the paper sheet beneath me.

"I'm sorry," the doctor said.

I barely nodded to her as I dressed and left the office. In the car, I let the sobs pour out of me. I cried all the way to Lili's house, not only for the life I had lost, but for my fear about what lay ahead.

My friends Kim, Kate, and Deb were at Lili's when I arrived. Our "moms' group" had been meeting every Friday in each other's home for more than a year. The four of them looked up when I came in. My swollen eyes answered their unspoken question. While Lili made lunch, I called Claude and told him about the baby that wouldn't be coming in March; neither of us could think of anything to say. Hanging up the phone, I joined my friends at the table and picked at my food, too numb to talk or eat.

Suddenly, the door to the kitchen opened, and the sounds of children playing spilled into the room. I turned to see Hannah standing on the threshold. She was wearing a sundress, a pink headband, and her new red shoes. She stood there quietly looking at me. Then she crossed the room, crawled into my lap, and began gently stroking my cheeks.

Perspective

Two hours later, Hannah dumped a basketful of hand puppets onto the floor of the pediatrician's office and sorted through the pile until she found the one she was looking for. Tucking a butterfly under her arm, she climbed into my lap, while I gazed absently at the diplomas and photographs on the wall. Already I felt relieved. Minutes before, Dr. Edman had gently examined her. His face hadn't registered any concern. He had asked us to wait for him in his office, standard procedure, while he made a phone call. Now he came through the door and sat on the edge of his desk.

"Is it possible for you to reach Claude at work?" he asked.

My brain struggled to register what he had just said. This was not standard procedure. What could be so important that I needed to call Claude?

"Hannah has a mass in her abdomen," Dr. Edman said gently. "I've called the emergency room. They're expecting you; Claude should meet you there."

I dialed the phone and, when Claude answered, repeated Dr. Edman's words.

"What does this mean?" Claude asked.

"I have no idea," I said.

Hannah slept in her car seat in the back while I drove. Forty minutes later, as I pulled into the emergency room parking lot and shut off the engine, I realized that I couldn't remember stopping for one light or stop sign all the way there. Either I had driven through every one, or I was simply too dazed to remember. As I unbuckled Hannah and lifted her out, a question pierced through the fog in my brain: Could a mass be cancer? I dismissed it immediately. How could I possibly think such a thing? Two-year-olds don't get cancer. Dr. Edman had said it was a mass. We would get it out, as simple as that.

As the automatic doors to the emergency room swung open, I felt better almost immediately. A nurse bustled toward me.

"Mrs. Martell?" she asked, partly a question, partly a greeting.

I nodded. Hannah lifted her head drowsily from my shoulder.

"It's okay, Missy," I whispered. "We're at the hospital. These people are going to help us figure out what's happening with your tummy."

"I'm hungry," Hannah said, closing her eyes and laying her head back on my shoulder.

The nurse led us to a small examining room. I sat Hannah next to me on the edge of the padded table. The nurse took Hannah's blood pressure and temperature and then asked me to remove Hannah's dress.

"No, Mommy, it's too cold," Hannah said.

I turned to the nurse, who shrugged her shoulders.

"I guess she can leave it on," she said.

Within minutes, a parade of doctors, nurses, residents, and technicians filed in, asked questions, took notes, and left, closing the door behind them. My sense of relief at being there was fading. I wanted Claude. I opened the door to the hall and startled a group of residents and nurses who were speaking in loud, conspiratorial whispers outside our room. I looked past them and saw Claude coming toward me, almost running, his head whipping from one side to the other as he read the numbers above the doors to each room. He looked panicked and disoriented, no more capable of knowing what to do than I was.

"Daddy," Hannah exclaimed as Claude came into the room. He and I embraced quickly.

An efficient-looking resident poked his head into the room.

"In ten minutes, Hannah is scheduled for X rays downstairs. An aide will be by to pick her up."

"Mommy, I want you to come with me," Hannah said.

"Of course, Missy," I replied.

The resident looked at me sternly. "You can go downstairs with her," he said, "but you can't go in the room unless you're sure you're not pregnant."

My voice sounded far away when I answered. "I'm definitely not pregnant," I heard myself say.

What had felt like the deepest loss hours ago was now enabling me to do the one thing I wanted more than anything else: to be with Hannah. Only my perspective had changed; the truth, that the baby inside me was dead, was the same, either way.

Light in the Shadow

The doctor came into the room, flipped the switch on the light board, and slid the film under the clip. I shifted Hannah's sleeping body to my other hip and leaned in next to Claude to get a closer look. The doctor used his pen to point to a large, dark shadow beneath the white outline of Hannah's ribs.

"There it is."

The pieces were beginning to fall into place. Three weeks earlier, during our vacation in Michigan, we had taken Hannah to an emergency room. She had been complaining that it hurt to lie down; she moaned in her sleep and ran a slight fever at night. The doctor told us she had the flu and sent us away with a sample-size packet of Children's Tylenol. Two days later, when she didn't seem to be getting any better, we took her to another hospital. The pediatrician there ordered X rays of Hannah's chest to rule out pneumonia, and then tried to examine Hannah's abdomen. Hannah screamed and refused to lie down, saying it hurt too much. The doctor gave up, obviously exasperated.

"There's nothing wrong with her; she's just manipulating you," the woman told us. "She's a typical two-year-old who doesn't want to go to sleep."

"How can we be sure it's not something more serious?" I asked, somewhat distracted. Will and Hannah, bored with waiting, had stepped outside the examining room and were now shrieking and chasing each other in the hall.

The doctor sniffed disapprovingly at the commotion.

"Well, look at her," the doctor said. "She has too much energy to be really sick. A sick child would be listless and lethargic, would run a fever all day, not just at night. She wouldn't put up such a fuss during an examination. If you want, make an appointment with her pediatrician when you get home; but as far as I can see, she's fine."

I felt confused and embarrassed by the doctor's words. Every bone in my body was telling me something was wrong, and yet, perhaps the doctor was right; maybe I was just the inadequate mother of an overindulged child. While Claude rounded up Will and Hannah, I quickly collected our things. Escorting our two unruly children past the other, obviously sick children in the waiting room, I felt guilty for having wasted a doctor's valuable time.

Now, looking at the dark shadow on the X ray of Hannah's ribs, I felt like a profound failure again. The doctor in Michigan had only been half right; instead of being the inadequate mother of an overindulged child, I was the inadequate mother of a very sick one. Why hadn't I trusted myself more? The doctors knew symptoms of illness as they applied generally to children. I knew Hannah. We were authorities on different subjects. I should have insisted that the doctor's explanation of Hannah's behavior didn't match what I knew to be true for her. Hannah had no interest in playing games to get what she wanted; she asked for it directly, demanding it if necessary. And why was she moaning in her sleep and running fevers at night? Even if these were unusual symptoms, surely they were signs of something more than manipulative behavior! Was I so afraid of making a mistake, so afraid of what these strangers might think of me, that I had failed my daughter?

As the doctor peeled the film from the light board, I knew one thing: I was going to have to start speaking up, before it was too late for Hannah. Before it was too late for me.

Just One Thing

it was past midnight, but not dark or quiet. the hallway's fluorescent light spilled into the room through the half-open door. A monitor beeped; the IV pump clicked. If I lay still enough, I could almost hear the whoosh of the pain medication pulsing through the line that fed a tiny vein in Hannah's hand. Because of it, Hannah was sleeping peacefully for the first time in weeks.