The Second Fight: The Balrog

“… Go back to the Shadow! You cannot pass.’ The Balrog made no answer. The fire in it seemed to die, but the darkness grew. “

J.R.R. Tolkein, The Lord of the Rings: The Fellowship of the Ring

** note: this post contains my experience of a D&C surgical procedure for missed miscarriage.

The Fellowship questions whether they have made the right decision in deciding to take the mines as a passage through the Misty Mountains. The dwarves who once inhabited the mines have been slain long ago and, to make matters worse, they are attacked by orcs as well as a cave troll! How will this journey end for the Fellowship? Frodo was now aware of Gollum following him around like a cold little shadow and the recent battle had left everyone shaken.

For more than five thousand years the Balrog, named Durin’s Bane, had taken refuge in Moria only to be woken from it’s slumber by the Fellowship as they attempted to cross the bridge near the end of their journey through the mines.

Balrog’s, in the Lord of the Rings, are described as ” generally taking the form of tall, menacing beings roughly in the shape of a Man, though seeming to consist or be surrounded by shadow. Constantly burning.” To someone who had never had surgery before, never had a general anaesthetic (let alone being admitted to hospital for any reason!) I guess I did see this procedure as being wrapped in shadow with the accompanying fear ‘constantly burning’ away in the back of my brain.

When given the option, we felt that having the Dilation and Cutterage (D&C) surgery was the best option because:
1. The worst would be over quickly rather than a build up and recovery like the natural miscarriage
2. I wouldn’t have to wait around for my body to realise what had happened which was better for me mentally AND physically
3. I would be able to have genetic testing done on our bumble to determine whether the cause of the miscarriage was genetics or something to do with my ability to carry the pregnancy – reassurance moving forward.
4. I could return to getting on with life quicker this way

It’s not hard to see why, after my last experience, that this pathway was a lot more appealing. The cons?
1. Surgery
2. A general anaesthetic
3. Cost (which was basically the excess on my private health insurance – thank goodness for that!)
4. Possible risks and complications (as with any procedure, but these were minimal and not all that different from a natural miscarriage).

So the surgery was scheduled for the Thursday, this was two days after our initial appointment with the specialist. Two days felt like a lifetime.
I filled out the hospital admission form online and read through the material I had been given. I should be ok to return to work the following Tuesday given everything goes as planned. I spoke with the Anesthetist prior to the surgery to ensure that I would not be intubated during the GA. Because this procedure is so quick (approximately 20 minutes) I will not be under for long enough to intubate unless they have to. He did give me the option of a spinal epidural instead but the thought of being awake and conscious for the procedure made that a hard no. Some of you may be wondering why I made this call, I was scheduled to be on stage for a performance in approximately 5 weeks after the procedure and needed to ensure that my vocal cords would not be at risk of a Julie Andrews moment. Having a LMP mask is much less risky so I am glad I made the call to check for my own reassurance.

The procedure in itself is fairly simple. Dilation is dilation. I don’t need to explain that – pretty much like the dreaded pap smears we all have to experience as being a woman. Cutterage refers to the use of a curette which is a tool designed to scrape away the uterine lining. I was early enough in my pregnancy to have a suction D&C which I am sure I do not need to go into much detail for you to imagine what that entails. Anyway, knocked out and all over in 20 mins.

20 minutes.

That’s so quick. Compared to a natural miscarriage of course which took over 10 days from start to finish. It all seems a bit clinical and cold when you think about it. So I tried not to dwell on that too much.

The lead up to the surgery was a bit of an emotional mess for me. I was torn between the thought of experiencing my first hospital admission, my first general anaesthetic and the fear surrounding the procedure itself. I think all the waiting between finding out we were going through another miscarriage and now this small two day wait for the surgery was starting to take it’s toll on my sanity. Knowing that you are carrying your lifeless baby and having to sit around and wait is really a curse in itself and certainly doesn’t do much for your mental state.

The day finally came for my surgery and I had been given strict instructions to fast from 8am. No food and no drink or water until my surgery which was scheduled for 4:30pm. My Samwise had taken the day off work to be with me which I was eternally grateful for and a clung to him emotionally and physically like a limpet the whole day.

** Here is a picture of a limpet for those who don’t know what they are… well, many limpets. FYI – the collective noun for a group of limpets is a bungalow and I feel that is an excellent fact to share. They are bastards to try and pull off a rock as they have mega suction. This was an accurate description of me at the time.

Preparing to go to the hospital was a mixture of relief, nervousness and fear. Relief because I had waited so long to feel closure, and the rest because I had never had surgery or a GA before. My husband reassured me that it would be ‘the best sleep I ever had’. I went with that as it sounded pretty good after weeks of disrupted sleep and bad dreams.

Pre-admission was fairly quick and the hospital staff and nursing staff were amazing. They took my blood pressure in a small room and asked me how much I weighed… I had no idea… and didn’t want to know. So I stood on the scale and felt even more awful when I realised the effect of no exercise, hormones and emotions all over the place. I had put on nearly 12 kg in the past 6 months alone. Apparently this is common, but I just felt like it was another nail in the coffin of my self esteem. I felt ugly, tired and hormonal. I felt angry that I had let myself get to this.

I was given a pill before they took me into the pre-surgery area. This pill is commonly given before a D&C and is called Misoprostrol. They gave me two and I had to place them in either side of my cheek and let them dissolve. Basically, this pill starts the miscarriage process by dilating the cervix which obviously makes surgery easier as your cervix during pregnany is basically Fort Knox… or that impossible door into the Dwarven Kingdom. It does also make you look like your cheeks are either super sunburned or on fire and also tastes like chalk. So that’s a bonus?

Anyway, it should start working in around 30 mins, so they got me tucked into a bed (with my little red hat on and red band as I am allergic to penicillin) and gave me a heads up about expecting some cramps but let them know if I am uncomfortable. More waiting, but having worked in a hospital for nearly 10 years, I at least understood the whole process from the other side. There was a couple of people in front of me. I briefly made eye contact with the lady who was before me as we passed each other in pre-admission. Her husband was there too.

The nurse came along to tell me things were going to be around 30 – 40 mins behind schedule and offered me this CRAZY bed heating thing where they basically blew hot air (gently) under my blanket. It was insane. I need it at home. The cramps had started but they were very mild, so they didn’t really bother me. The anxiety and waiting was honestly worse than anything physical.

My doctor came and spoke to me and asked me if I had any questions about 5 minutes before they took me around to surgery. He told me they would give me an anti-D shot in recovery too. This is generally a precaution with surgery as I am a negative blood type and my husband is positive. This basically means that if the baby has positive blood and our blood mixes that my immune system will develop antibodies towards positive blood. This won’t affect me with this pregnancy but can with subsequent as if that little antibody army exists they can attack the growing fetus if they are also positive.

If you want to know more about anti-D, check this out: https://www.pregnancybirthbaby.org.au/rhesus-d-negative-in-pregnancy
Also, your plasma donations help the anti-D program so donate blood today: https://www.donateblood.com.au/anti-d-program

I didn’t have any questions. Well, if I did they weren’t in the forefront of my mind… obviously in line behind all the emotions and nervousness. Suddenly the whole ‘clinical’ side of what was about to happen really hit home. I was beyond ready to get everything over with, especially with a missed miscarriage. I told myself that without this surgery I could be waiting weeks. I could get an infection. I wouldn’t be able to have the genetic testing to help determine what went wrong. The worst would be over soon (unlike the last time!). So the pros outweighed the cons.

But I was still sad. Our little bumble would be surgically ‘suctioned’ out. That sounds so awful no matter how I try and word it.

I said goodbye to my husband and put on my best brave face. Red cheeks and all.

I forgot just how many people there are in an operating theatre. It has been nearly 8 years since I have been in one myself (albeit scrubbed up and on the other side to observe Orthopaedic Surgery). There was my anaesthetist, his assistant, three other nurses, my surgeon and his assistant. That’s 8 people including me! The lights are bright and the whole thing made me feel a little confronted and embarrassed (even though I knew it was all part of it). My bed was moved to the side of the operating table and I slid myself over on the command of the nurses.

My anaethetist was lovely and him and his nurse took over from there. He gave me an anti nausea drug first through my IV and then the GA started. The last thing I remember is the nurse saying:

“Are those your natural eyelashes?!”

“Yes.” I replied

“That’s insane, I wish I had eyelashes like that…”

Then nothing.

Next thing I remember is opening my eyes in recovery. Like waking from one of those dreams where you think you are falling and you almost startle yourself awake.

“You’re in recovery, it’s all over”

The lovely nurse said to me as she sat beside my bed and placed a hand on my shoulder.

“It all went perfectly, your husband is on his way. We are just going to monitor you and let you wake up properly. Then you can have a much needed cup of tea and something to eat”

She smiled gently and I felt relieved.

There was a little bit of cramping but otherwise I felt fine. A little ‘out of it’ but thankfully no major nausea. They gave me some paracetomol via my IV for the cramps.

“This stuff is a lot better than the tablets! Just you wait!” laughed the nurse.

After about 20 minutes she instructed me on how to get out of bed and get myself changed. I noticed they had already given me a sanitary pad but there was virtually no bleeding anyway until I stood up, thankfully it’s nothing more than the awful changes in posture you get with your period. Ladies, I know you understand that. Men, count yourselves lucky.

I slowly got myself changed as my head was a little woozy. I kind of don’t remember much really in the way of what I was feeling. Emotions were a little numb. I was happy things went well and that the worst was over. I just wanted to go home with my husband.

I can tell you, after fasting from food and water since 7am I was pretty happy to have a simple sandwich and a cup of tea. The cramps were extremely mild (if you are used to normal period pain) and, apart from being a little tired and slow I was feeling ok. I lay in the reclining chair and waited patiently for that familiar face to walk through the doors.

Soon enough he came and I felt relieved and less numb. My Samwise always brings lots of love and has the best cuddles for times like these.

“Let’s go home, baby” he said as he helped me up.

We were given some information and said goodbye to the lovely nursing team. I have to say a HUGE thank you to the team at the Waverly Private Hospital. They were all so caring and warm. No one made it feel any more clinical than it was and the kindness certainly helped to make a less than pleasant experience more tolerable. Thank you. What a hard area of the hospital to be a nurse in. So much sadness and emotions.

Recovery was fairly straight forward. I had a quiet 3 – 4 days at home with bleeding lasting a couple of days and very minimal. I did have a small freak out moment when bleeding returned 5 days after the surgery, but this is normal in some cases and my wonderful surgeon reassured me when I made a typical panicked phone call.

The one thing I have to say is prepare for the GA to muck with your bowels. Generally you end up constipated which, on top of everything else, is extremely uncomfortable. The downside? You can’t strain as it causes fabulous sharp pains in your tummy and cramping! Bowel and uterus are kind of close buddies and cramping in one generally upsets the other. If you have experienced this you totally get me – if not, and you are worried DON’T BE…. it’s normal and will pass after about a week or so. If in doubt, DON’T DR GOOGLE! Call your friendly nurse or surgeon.

My surgeons team called me to check up on me the next day and after two weeks. The hospital also called to check on me after a couple of days which was super lovely.

I don’t really know what I felt at this point to be honest.

Angry: that this had happened again, that I had to go through this, that WE had to go through this. Angry at my friend who were pregnant and managing this so easily and we just couldn’t.

Upset: at the fact that my body felt like it was failing me. I was upset at bleeding again. Upset that I couldn’t do what I was meant to be able to do as a woman. Upset for our future.

Relieved: that the worst was over with the surgery being done. Relieved that we had a good doctor and testing being done.

Numb: emotions were so much that I just shut down really. Overwhelmed and over-processing.

I felt crampy. moody, achy and just generally horrible. I had been told not to exercise and was comfort eating and had put on 10kg since the first pregnancy.

I hated myself and the way I looked. I shed tears trying to put on clothes, looking at my ‘useless’ body in the mirror and wondering what I did to deserve this.

I scrolled through pictures of myself on Facebook and beat myself up further for believing I was overweight or ugly back then. I can tell you it’s nothing to what I was feeling now.

Its cruel.

You go through so much and so does your body, and at the end of it you look at yourself and that makes you feel even worse. My body was useless to me and I felt horrible. I didn’t understand why my husband still wanted me around. Why not just trade me in? Someone younger and sexier who can do this thing I couldn’t?

You beat yourself up so much. There is so much to be upset and angry for and although you tell yourself that it’s not the case – the feelings remain and are hard to shake off.

I remain tired with little self confidence these days. I have tried to get back on the horse of exercise and weight loss and feeling good about myself but it’s so hard. If I had the choice again I would certainly do the surgery – but my mind still wanders and wonders whether I have scar tissue and because of that surgery I will now struggle to get pregnant. Such a small chance of that happening. But there is such a small chance of being like me and having multiple miscarriages – so while the world is handing out the bad luck… what’s one more thing?

Recovery was quick in the end really. I was back to work the following Tuesday and struggling through my days. I performed in a show 4 weeks after my miscarriage, still battling a hormone ravaged body and voice. To top it off, I got my first period after the D&C 3.5 weeks after (as predicted) and just before opening night… cos you know… why not?

The Balrog was a fight. I feel like whatever wizard I had walking this path with me and hopefully going to use some magic to help me get through it all … was gone. Like Gandalf.

Now all I felt was sadness, me and Samwise… walking hand in hand, dirty, emotionally at a loss after the fight, tired, defeated and carrying a heavy burden between us.

Gollum followed us everywhere. Some days he is close and I feel lost, angry and emotional and like giving up is the best option. Some days he trails further behind and I get a sense of normalcy… for a second.

For even the very wise cannot see all ends. – Gandalf, Lord of the Rings

The road looms ahead and we trudge on. Numb, but clinging to some hope. There must be something to cling to, right?

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