Saturday, April 25, 2009


Wikipedia: "a sudden emotional climax that evokes overwhelming feelings of great sorrow, pity, laughter or any other extreme change in emotion, resulting in restoration, renewal and revitalization"

Aristotle: "language embellished . . . through pity and fear effecting the proper purgation [catharsis] of these emotions."

Elisabeth Kubler-Ross: "When you learn your lessons, the pain goes away."

In tragedy, catharsis is a public event. Fifth-century Athenians gathered on the side of the acropolis at the theater of Dionysus to collectively watch the demise of dramatic heroes. When Jocasta took her life, it was not just her husband who mourned, but the whole audience. As the actor for Oedipus donned a mask with bloodied eyes, the spectators followed his every action, listened to his words, and empathized with his pain. Experiencing tragedy from behind the safe barrier of our suspended disbelief (and fiction at that) allows us to purge our own emotions and to walk away from the story afterward with a sense of relief, renewal, and redemption. Or so the theory goes.

Forgive me for making this story of my miscarriage so public. Selfishly, writing is cathartic. I also chose to share my joy, so I find myself now sharing the loss. I am amazed to discover how common this loss is and how many close friends have felt this pain too acutely. My dad pointed out that because we had told so many people about the pregnancy, we at least do not have to keep our grief a secret from those who might help us through it.

It reminds me a little of the liturgy in a Lutheran church service when the congregation as a whole recites a confession of sin. The words are rote, we speak en masse, and it even uses the pronoun "we." It is impersonal and highly personal, seeking renewal through grace.

That's as far as I'm going to get with religion on this topic. Literary criticism comes much more naturally to me. I've read too many books to not compare my life to literature, to not seek out the interesting characters, to not look for symbols and themes in the world around me, and to not hope for some elegant denouement of all my conflicts, even the tragic ones.

Like any educated ancient Greek sitting on the stone bleachers, I knew how this story was going to end. That small advantage of knowledge made all the difference. Even in the most painful parts, I could step back and consider it all part of a process, a scripted sequence of events that would lead to the end of this short chapter in my life.

So yesterday, lying down in a tiny 9x4 closet of the ER with an OB patient table and a very poorly placed door, I faced my own catharsis.

I had been given three choices. The idea of any degree of choice in a matter like this is of little comfort. Option 1: Wait it out ("expectant management"). Option 2: Take medication to speed up the process. Option 3: D&C. Everyone I spoke to tossed off this acronym like it was common knowledge or taboo to actually explain it, but I admit that I kept associating a D&C with the Democratic National Convention. I'd much rather attend the DNC.

I just started reading this awesome little book Nudge about guiding choice architecture so that people have the freedom to make good decisions while being nudged a little in the direction that would have the greatest benefit to one's general health, wealth, and happiness. Thus it was hard not to analyze the way I had been presented these choices ("No one wants to go through a medical procedure if they can avoid it") and to wonder which would have the greatest benefit for us. Rightfully perhaps, my husband wanted no part in telling me what I should do, nor did my pregnant doctor friend nor my colleague who had endured a similar miscarriage herself. All three offered to help me learn more about each option, as they emphasized that this was a personal preference decision I needed to make for myself and my own body. My mom said I should get the surgery.

I decided first to wait, then 12 hours later to call my doctor and schedule a surgery for next week if the waiting wasn't working, and I was on the verge of asking for the medicine when I became impatient the next day. My OBGYN beat me to it and ordered me to take the prescribed medicine anyway. Yes, I chose all three. Apparently the authors of Nudge are right--humans suck at making important decisions when they lack experience, good information, and prompt feedback.

Within an hour, I was bleeding too much and too fast, so we drove to the ER instead of the pharmacy despite the doctor's initial advice. My husband cursed and drove 100 mph while I listened to elevator music on my cell phone and was finally told, "It's like a heavy period. You'll continue to bleed a lot." It's hard not to be skeptical when your body is gushing blood continuously for hours and very educated people had forewarned me that was bad. "So what is the warning sign that I might need help?" I asked. Honestly, was I supposed to measure it in liters? Wait until I passed out? "Let me ask the doctor. . . . Ok, maybe you should go to the ER now, but go ahead and pick up your medicine first."

We weren't thrilled at the idea of backtracking 15 miles to wait for a pharmacist to fill a prescription while I turned the drugstore into something resembling a crime scene. ERs have drugs, too, so that's where we went. At the hospital, they rushed me to the room mentioned above where I waited to be seen and tried not to pass out or to wonder where I stacked up in the triage order. Ironically, the first person I saw was a lab assistant who came to draw some blood.

I was scheduled for a D&C. They swaddled me in blankets and wheeled me down to the radiology department where I had seen my son's face for the first time. I cried, my husband waited nervously, and a nice lady named Ashley performed the worst part of her job as an ultrasound technician.

By the time the ultrasound was finished, I had been moved to a real bed and hooked up to an IV, my doctor had been contacted, and I had learned the names of all the nurses on call (5 hours since everything started), my body self-righted. Everything was purged. They canceled the D&C but gave me the medicine anyway as a precaution against infection and sent me home in time to pick up our kids for dinner. So much for choice, but I'm not complaining. I don't mind the illusion of choice if it gives way to the reality of ensuring my health and safety.

I ate the best-tasting steak of my life with the family I love dearly. Even though we all spent the dinner staring glassy-eyed at the tv, exhausted, saddened, weak, or too young to get it, I couldn't have wished for a better evening. We had apple pie for dessert and went to bed early. I looked forward to a new day, the beginning of an uncomplicated weekend, and a new opportunity to re-examine my hopes and dreams for the future.

I don't pretend that my grief is gone, but I believe that I am sliding my way down the plot diagram to a gentle resolution.


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