Maternal Fetal Medicine visit

We got the first and only available appointment today at the Maternal Fetal Medicine specialist that my reproductive endocrinologist referred me to; given his referral, they were able to squeeze me in this last minute, which I was grateful for. Chris and I went together; I wasn’t sure I could stomach any more bad news this week, and I absolutely did not want to be by myself if I had to hear more crappy news.

Typically, if you are having any complications during pregnancy, whether it’s preeclampsia, gestational diabetes, or abnormal growth with your fetus, that’s when you’d see a maternal fetal medicine specialist for more careful monitoring and direction. Otherwise, you’d just go to your OB-GYN for routine visits and scans. Sitting in the waiting room here was a bit unnerving; it was very clear I was the only patient in the waiting room who was so early on in her pregnancy; everyone else looked at least six months or more along.

We were invited in, and after undressing waist down, a sonographer came in and performed the longest transvaginal ultrasound I’d ever had, ever. She took so many pictures at so many angles, zoomed in and zoomed out; it was certainly an extremely thorough ultrasound. She confirmed that Twin A no longer had a heart beat, and well, even worse: it had already started shrinking in size even just from yesterday. She also confirmed that Twin B was progressing well, with 171 beats per minute. She took a very close up shot of Twin B and printed it for us. She identified where the brain, head, and tush was. Twin B is currently the size of a kidney bean, and it certainly looked like a little shrimp at this point. She then completed the scan and said the doctor would review the results and come in to discuss with us.

When the doctor came in, she seemed confused as to why we were even here. “Did your fertiilty doctor want to confirm that it was twins….?” she asked, confused. “Yes, it was definitely twins.”

No, I told her. We knew it was twins all along, but the doctor wanted to confirm they were in their own sacs. She said they were, in fact, in their own sacs, so Twin A not progressing would not affect Twin B; Twin B would basically progress as though it was a singleton pregnancy all along. She did say that the two twins did originally share the same placenta, so I had a moni-di pregnancy: this means I had a monochorionic, diamniotic twin pregnancy: one embryo that split into two, which would have been genetically identical offspring. These twins share a single placenta (blood supply) but have separate amniotic sacs.

So thankfully, since they are in separate sacs, Twin B would be unaffected. And I hope for the best for Twin B’s progression. And while I have calmed down since yesterday and feel relief that Twin B will be unaffected by Twin A’s death, I still feel heavy in my heart for A. I was also annoyed that the doctor today seemed pretty un-empathetic and so matter-of-fact. She also just stood in the doorway and made it clear that this would be a quick, couple-of-minutes long conversation. It felt very rushed. While I get that vanishing twin syndrome is very common, she really doesn’t have to be so robotic at sharing this and completely disregard my feelings as the person who was carrying these two embryos. Some doctors are truly just assholes. Given there appeared to be no other complications, she said, I didn’t need to follow up with her and could just go back to my clinic doctor. Thank god, I thought. I did NOT want to continue working with this doctor again. She kind of epitomized everything I hate about the worst New York doctors.

Now, I just have to hope for the best and pray for Twin B; my little embryo that could. You can do this. We got this.

The vanishing twin

Chris and I arrived at the clinic and waited for quite some time to be brought in for my ultrasound. I was a little annoyed, especially seeing that so many patients who came after me were getting called in sooner than I was. I asked the front desk what the hold up was, and they told me that they were a) waiting for a bigger room since Chris was with me, and b) the doctor would be doing my scan since I’m nearing the end of my time with the clinic, so it’s like a “farewell and good luck” parting. That made me feel sad, though, because I always look forward to seeing Mina during my scans; she has been my rock at this clinic since I first started coming, and seeing her is always a comfort to me.

When we got to the exam room, we waited for the doctor and his medical scribe to come in. They eventually came, and the scan began. But something just didn’t seem right. The doctor was silent for a much longer time than I thought he’d be as he examined one of the twins. I looked at his face, and he looked like he was wrinkling his brow and squinting. He kept zooming in close on one of the twins to get a closer look. I was getting worried.

After what felt like forever, he said quietly, “I’m so sorry. I do not see a heart beat.” He was referencing Twin A.

As soon as he said that, I felt like all the sound coming into my ears had just gotten sucked into a vacuum. I went numb. It was like nothing else mattered at all. In that moment, I just wanted to die.

“You don’t?” I managed to squeak out. He responded “no” quietly.

“What about the other twin? Is the other twin okay?” I asked. He took a look at Twin B, which was progressing well and had a heart beat in the target rate, at 169 beats per minute.

He suggested, for “peace of mind,” that he refer me to a maternal fetal medicine specialist to double check that the two twins were in separate sacs, as if they are in the same sac, that could pose some risk to Twin B. Unfortunately, the ultrasound machine at the clinic just isn’t high powered enough to confirm this to be true 100 percent. Chris started asking him questions about how common this was. He told us this was a fairly normal occurrence and tends to happen about 25 percent of the time; they call it “vanishing twin syndrome,” and they said it’s extremely common and “happens every day” with embryos that split into two. There is no concrete reason for why this happens. Twin A would either get absorbed into the uterus, placenta, or surviving twin, so it would not get expelled as with a regular miscarriage. He was trying to be empathetic, and said that it may take some time for us to digest this news, but he’d be available for a phone call if I had any questions at all or just wanted to talk this through. He then told us to take all the time we needed and left the room. His scribe went to get me some water. And as soon as they left, I just sobbed nonstop.

The doctor informed Mina right after he left our exam room, so she immediately came in to comfort me. I was so happy to see her despite the awful news. My clinic rock had shown up to take care of me.

I’d read at a cursory level what vanishing twin syndrome was after my 5-week scan, when Mina said she wasn’t 100 percent sure if she saw a second gestational sac or not. But at that time, I didn’t quite get the magnitude of how common it was… or that it could actually affect me. Of course, I worried a little about it, but I tried my best to hope for the best, to be cautiously optimistic, to be in the moment. “I’m going to be a twin mom,” I kept thinking, smiling to myself. I even started looking up how to raise twins and what the different twin stroller options would be, particularly for travel.

Every week since week 4, I would begin and end each day marveling at how lucky I was to have gotten this far, and to be doubly blessed with twins when I had only one healthy embryo. Every week, I just basked in gratitude that all my visits to the clinic had gone so well. I’m so lucky and blessed, I kept telling myself. How could I possibly be this lucky? I kept asking myself. I ended my first and only IVF cycle with only one viable, genetically normal embryo, and somehow that little embryo that could split into two; TWO POTENTIAL BABIES. I was just in disbelief that I could be this blessed. And I wasn’t sure when and if my luck would run out. And then when this devastating news hit me today, it was like all my joy just got sucked out of me. My attempt to live in the moment had just been shot to death. One of my babies had been taken away from me nearly as soon as it was given to me. The pain that took over my insides was just indescribable. One of my babies had died inside of me and I had no idea until that moment.

Just last week, I had two healthy, growing embryos the size of blueberries, both with their own gestational sacs, yolk sacs, fetal poles, and strong heart beats. What had happened to Twin A? How could it just have died just like that with no warning?

Vanishing twin syndrome is technically considered a miscarriage; it’s a pregnancy loss. While you still have one surviving twin, you have lost the second. I always knew academically that miscarriage would be devastating and could bring on depression. I just never had any idea exactly how awful it could be until it happened to me, even with one surviving twin. I want to be happy that I still have one little survivor, but I cannot help but mourn the loss of my second twin, who I cherished and grew attached to in the last three weeks. They were some of the happiest weeks of my life; I had never been more full of gratitude for my blessings than during that time.

This loss feels very real to me; I once had two strong heart beats inside my uterus, and now I have only one. I just don’t understand why this had to happen.

Who’s going to go first?

I was on the treadmill this morning, doing my usual morning jog to start my workout, thinking about all the times when Chris and I had spent time with Raj and his wife Maria. We’d had so many conversations, serious, fun, jokey, hypothetical, about the past and future; everything. I was thinking about all the things we’d talked about. Raj was so openly vulnerable and admitted how much he depended on and needed Maria; it was so sweet and adorable. We talked about our future hypothetical deaths once.

“No, I definitely need to go first,” Raj admitted, squeezing and bear-hugging Maria. “I can’t live without Maria. I just don’t know what I’d do! I need her for everything! I don’t care how that sounds; it’s just true.”

Chris insisted the same in different words, saying he’d definitely go before me. I gave them both annoyed but comical looks; I hated discussing our future deaths. This kind of topic always made me feel so sad. I wanted to focus on the now and the positive.

What none of us realized at that time was how soon Raj’s “going” would happen. Usually, when we think of our deaths, we think it will happen decades and decades later, not in the prime of our lives in our 30s.

Even if Raj did live as full of a life as he possibly could, it’s still robbery that his life was taken this soon. It just hurts to know that we’ll never see his huge smile or feel his big, nearly crushing bear hug ever again.

When those you love die, where do they all go?

Raj’s untimely passing reminded me of Ed’s passing. In my adult life, they are the two people I’ve lost that I have genuinely cared deeply for. They both lived such different lives, yet passed away at similar ages. Ed passed away just a few weeks shy of his 34th birthday. Raj was only 36 (I think?). Raj had traveled the world and truly lived life to its fullest. Ed had never left the country and was just asking me months before he passed about the passport application process. Raj had friends pretty much everywhere and was a true extrovert. My brother was socially awkward just like our dad and had no real friends… just like our dad. Raj had a loving and close relationship with both his parents, to the point where he even called his dad his “best friend.” My brother had a tumultuous relationship with our parents, always with endless conditions, lots of judgments, and our dad barely acknowledged him until after he died.

When I look back at Raj’s life, or at least, what I know of it, he truly did “live life to its fullest “as trite as that sounds. He made the most of every single day. He did as much as he could wherever he was. He hated wasting a moment and was always just so damn positive. When I reflect back on Ed’s life, something held him back quite a bit. Part of it, I’m sure, was the fear my mom instilled in him of the world, always believing something bad was going to happen when you turn the next corner. The other part of it was that he just didn’t have the parental love and support system he needed to be secure in himself to go out and explore the world and really be independent in the way that Raj was. Ed had a lot of potential that just never got seen or recognized. Raj had all the potential that was seen, recognized, and appreciated. And then life had a different plan for him than to continue on with us. Their deaths were a tragedy, but more, as sad as it is, will look at Raj’s life and truly feel it was tragic, whereas with Ed, he has likely already been forgotten by most people who knew him. The world is a cruel place, during life, and even in life after death.

I wonder… if there truly is an after life, a heaven, will Raj meet Ed? Will they have a conversation? Will they have some sort of connection because of me? One day, when it’s my time, will they open up the gates for me?

When the worst news comes.

I was in the kitchen early this afternoon when Chris exclaimed that he didn’t believe something had happened. I asked him what it was, and he wouldn’t tell me. Instead, he came over to show me the email that was sitting in our inboxes. I was shocked to read that a good friend of ours, who we used to hang out with regularly, while he lived in New York City, had passed away suddenly and unexpectedly due to a seizure. He and his wife had just had a baby just over a month ago, their first child, and we had just spoken with them on a Zoom call in early March when they were getting ready to drive down from Sacramento to the Big Sur for their baby moon.

I immediately just felt sick. I was literally just thinking about messaging them to ask if they wanted to do a Zoom catch-up since it had been a little over a month since the baby had come home, and I figured they’d need some time to get into the swing of things before socializing, even remotely. I didn’t even know what to say. I just felt hurt, shocked, disgusted that something like this could happen to someone who had just welcomed their little baby into this world.

Anyone who knew Raj even remotely would know how full of life he was. All you have to do is look at a photo of him, and he just looks like a big teddy bear: someone who is just so affectionate, tender, kind-hearted, well-meaning, who just screams to be hugged and loved. He is so expressive, so generous, and so thoughtful. Behind my current “desk” setup, we have the bottle (now empty and cleaned) of champagne he sent us from one of his favorite wineries in California. It was a celebratory bottle he sent us shortly after we got married in March 2016 when he and his wife were living temporarily in Switzerland. He had shared that when he and his wife visited this winery and loved the bubbly so much, they knew they had to share it for special occasions with their friends and family when an event came up that warranted it. So he had this bottle engraved for us.

Making new friends as an adult hasn’t been easy, at least for me. Meeting people I genuinely click with, who I can say whatever I want in front of without fear of offending, who I feel actually get and appreciate me, has been a challenge. And well, a city as impersonal and time-strapped as New York, it’s even harder I’d say. With Raj, I always felt like I could be myself. He was an accomplished and overly educated person, having spent a lot of time working and living abroad throughout his short life. He was truly a citizen of the world, constantly curious and wanting to learn, do, see, and eat more. From the time we met him on that food tour a friend of mine arranged in 2015, we immediately clicked and got along. He made it clear he wanted to see us again, and we met him for dinner with his wife downtown. We continued to spend time together regularly until 2018, when they finally moved west to Sacramento, in an effort to be closer to family on both sides and also to start a family with more space.

Raj defined loving and expressive. He always told us, in his cheesy, cute way, how much he appreciated and loved us. Even after they left New York and we’d catch up over FaceTime or Zoom, he’d always say that while he loved having family nearby, he really missed having friends like us close by. He never failed to share how much he enjoyed my cooking and the food I made… to the point of inviting himself and his wife over for lunch during a New York City visit in 2019 when he was here for a work trip. While I may have been annoyed if anyone else had tried to do that, with Raj and his wife, I was just so flattered and felt so loved and appreciated. I still remember when they came, which was the last time we saw them in person: they came in March 2019, and they showed up with a bouquet of flowers and a massive box of Levain cookies (which of course, they got themselves their own massive box for their flight back home to Sacramento).

My heart just hurts for Maria and their newborn Jay, and for Raj himself. It’s so fucking awful and unfair that this happened to someone as kind, genuine, and amazing as Raj. He was so full of life. That sounds like a trite statement, but he really was all those words: Full. Of. Life. I still remember how excited he was to start a family and to meet Jay. He even posted on Instagram that he was reading a book for expectant dads; I know for a fact he would have been a devoted and extremely loving and hands on dad. I just can’t get over how unfair and awful this is.

Life is really short. It is too short. I don’t even know what to say anymore.

Staten Island – it only took 13 years

Since I moved to New York, I’ve visited four out of five boroughs pretty regularly. I lived in both Queens and Manhattan. I went to Brooklyn all the time. I’ve enjoyed the Dominican and Italian food in the Bronx, not to mention a number of visits to Yankee Stadium (with work, obviously; I can’t stand baseball). But the closest I’d ever gotten to Staten Island was taking the free Staten Island ferry from Manhattan to Staten Island, just for the free boat ride, and then boarding the ferry to come right back. That’s a little embarrassing, but I knew Staten Island would not be an easy place to get around, and it seemed like a foreign land to me even though it’s technically part of New York City.

Today, Chris rented us a Zipcar, and we finally made our first visit to Staten Island. It’s pretty spread out, so it would be pretty much impossible to explore on foot. There is a bus system through the island, but who the heck wants to rely on that to get around? We made good use of time, grabbing some Italian pastries and freshly baked bread from Royal Crown Bakery, eating delicious Sri Lankan food at Lakruwana along Bay Street, and even stopping at a brewery for local beers on tap (well, for him).

While at Lakruwana, I read an article that was recently published on them in January. While I’d read in the New York Times that Staten Island had the biggest Sri Lankan population in New York City (and actually, the biggest Sri Lankan population outside of Sri Lanka!), I didn’t realize that of the 5,000 Sri Lankans here that 30 percent of them reside in Staten Island. I’m sure there are historical reasons for that, but that made me sad that Sri Lankan food was not closer to us for us to eat more frequently. Lakruwana actually originally opened in the mid-90s in Hell’s Kitchen, but after a fire that burnt down the entire restaurant, when the owners, a husband and wife team, were asked if they wanted to re-open in the same area, they decided it would be easier for them to re-open but in Staten Island, since it would be an easier commute for them given they lived there. And so the Sri Lankan population grew, plus the restaurants in Staten Island.

New York City — I’m so blessed to call this extremely diverse place my home. How can you get bored of New York when you are constantly visiting new places like this right here?!

Wellness Day and back in Chinatown

“You always go to Chinatown on your days off,” Chris remarked teasingly when he found out that i went down to Manhattan Chinatown today. While it is not always accurate that I go down to Manhattan Chinatown, it is usually pretty accurate that I go to some Asian area of the city. My general thought around that is… on my day off, I want to get food, and I also want to support local businesses. And thus, Asian food and groceries are not only delicious but a great value, and in addition, I want to support Asian businesses because of the awful impact this pandemic has had on them.

I went to some of my usual standbys, like Fong On for soy milk and grass jelly, and Manna House for some different baos. I also went to a few new spots, such as Tonii’s Fresh Rice Noodle Rolls, Hay Hay Roasted, and Golden Steamer. Unfortunately, I arrived at Golden Steamer too late, and they ran out of their signature pumpkin baos, but they still had their “big bao” or “da bao,” which is stuffed with a pork filling, egg, plus Chinese sausage.

Chinatown always feels like home to me, even when I am discovering new businesses and new foods. And well, of course the food never disappoints.

The first pregnancy-related food aversions

On Thursdays during the pandemic, we look forward to ordering food delivery from a local restaurant, not just to increase the variety of the food we are eating but also to support our local restaurants, who clearly need all the business they can get during these times. Today, Chris decided to order Korean from a spot near Koreatown called Cho Dang Gol, and as he usually does he ordered a large variety of dishes to last a number of days. As I opened each of the containers, I was struck by the smell of one of them specifically: it was a fried fish dish, and while I am normally a fish lover and look forward to all things seafood, the smell just seemed off to me. But, there’s no way the food itself could have been off… Cho Dang Gol is a reputed restaurant we’d eaten at numerous times. What was going on?

I tried to ignore the initial disgust reaction I had when I opened the container, and Chris served us a little of each dish. The fish was also on my plate. When I originally took a bite into it, while it felt meaty and chewy in my mouth, I could not get over the smell. It just smelled… rotten to me. My brain knew it wasn’t rotten, but I couldn’t get over the smell. I did not want to waste the food, so I didn’t spit it out and forced myself to swallow it. But I knew if I tried eating the rest of the fish on my plate, I’d probably throw up.

I told Chris that the smell made me feel nauseated, so he told me to stop eating it and to leave it aside. We continued eating our dinner, and he said, pensively, “I hope this is just temporary.”

Who’s he telling that? Fish is one of my favorite things to eat, especially SALMON or any other fatty fish. The added bonus is that it’s in general healthier than meat and is rarely lacking for flavor. And with Asian preparations, fish is so quick and easy to make.

I’d heard from many people about random food aversions during their pregnancies, especially to foods they absolutely love normally. Is fish going to be it for me?

7-week scan

I went by myself today to my seven-week appointment at the clinic. On my walk over, I realized that if all goes well, this will be my third to last visit before I graduate. It was a bittersweet thought, especially since there are some individuals who work here who I really have enjoyed seeing regularly, like my sonographer.

During my scan, all looked well. One twin is growing a little faster than the other, which is normal, as the sonographer and doctor both shared; it’s pretty much impossible to have both twins growing at the exact same rate. But the real stopper was when Mina let me listen to both of their little heartbeats. This week, they have both grown to the size of blueberries and are just beginning to sprout arms and legs. I heard both heart beats loud and clear and almost stopped breathing: my tiny little babies have super strong heart beats. I just couldn’t believe how surreal it was. They are both between 131-134 beats per minute, which is exactly in the range where they should be, the nurse later called to explain to me.

After each appointment and nurse call in the last week, I’ve let out a huge breath of relief to hear that everything has been progressing well. I’m hopeful yet anxious that all continues to move forward in a positive direction.

My two little babies; I still just can’t believe it.

When you can’t tell anyone

I went to visit our sister apartment building two blocks away to view some potential 2-bedroom, 2 bathroom units. It’s a little funny when you are in your first trimester of pregnancy and don’t want to tell others outside of your closest circle that you’re pregnant because you’re not sure if it’s going to last. But you also want to indicate that you need more space.

“Are you sure you need a 2 bed?” the leasing consultant asks me. “Because I have a HUGE 1-bedroom, 1.5 bath that would be PERFECT for your budget, and wait until you see the kitchen!”

I did view it for shits and giggles and could not believe how much storage space the kitchen had, not to mention how big the kitchen island was. But yes, I told her. A 2-bedroom was non-negotiable. “It would be my office,” I said. “I’m going to be working from home full-time even after this pandemic is over, and I need dedicated space.”

Well…. I thought about that, too. Let’s say this pregnancy does work out. That second bedroom, realistically, is NOT going to be my home office. It will be the bedroom with the babies. So does this mean I’m left with the same result… WORKING AT THE DINING ROOM TABLE AGAIN???

I don’t really want to leave New York City, but the cost for space here is just outrageous.