Chase had said to me that morning, "Do you want me to come with you?" I declined. It's an 11:30 appointment right in the middle of the day, and it will be routine I am sure.
I got there on time, and Connie, the ultrasound technician was great. She was really sweet. She asked me to tell her what was going on and answered my questions as she looked at my belly. But it took a really long time. So I asked what she was seeing. And she didn't say much. "There is some large swelling and a mass over here... and some fluid over here...but there is nothing in your uterus. You shouldn't be bleeding at all. I can't figure this out. What you've told me doesn't really make sense with what I'm seeing."
Back to the lobby. When Jeff called me back, he looked at me and said, "What's going on with you?" Um, I don't know, you're the doctor. We went into a room to discuss what the ultrasound was showing. His bedside manner is great, but he was obviously having a hard time getting to the point. While he talks I'm thinkgin--Ok, so I'm not having a D&C? Oh good. But what was in there? Why am I bleeding again? And out of the blue...
"You have two options; chemotherapy or surgery."
You have the wrong patient file. Sorry, try again. But then he went on. There is a mass in my left Fallopian tube. It is 3.8 cm in diameter. It's the pregnancy. There is no heartbeat, no baby. The baby died weeks ago. But the placenta is still growing attached to the wall of the tube. It's called an Ectopic pregnancy. The stress on the tube as it stretches around the growing mass is where the bleeding is coming from. The fluid in my abdomen is blood from the tube as well. It's bleeding out both ends. It's not a dangerous amount of blood though. The chemotherapy of choice is called Methotrexate. It is no longer used on cancer patients, but it is used on MS patients, other diseases, and Ectopic or tubal pregnancies. The mass is growing at a rapid rate; it is larger than a normal pregnancy would be at 8 weeks. They treat these ravaging placentas like cancer because they will do anything to survive and grow, even without a baby to support. Methotrexate targets and kills rapidly dividing cells, ie. cancer. So the idea is the chemo will cause the mass to stop growing, and be reabsorbed into my body. I won't lose my hair, and will hardly notice any symptoms at all. Ectopic pregnancies are dangerous. They can cause the tube to rupture and internal bleeding can go undetected. The chemo is used when there is no heart beat, the mass is smaller than 3.2-3.5 cm in diameter, and HCG levels are below 5000. Otherwise, the mass is too strong to be thwarted by the chemo, or the risk of rupture is too high, and surgery is the alternative.
As he talked, I listened. I didn't cry until I tried to ask a question. He was very kind and supportive, but anxious. He said I needed to get the chemo immediately. Although the mass with slightly larger than is usually treated with chemo, surgery is always the last recommendation because it is more invasive. I went to get my blood drawn so they could verify that my HCG was low enough, and it was; 1485. Normally a pregnancy at 8 weeks produces HCG, the pregnancy hormone, in the tens of thousands. So my placenta was producing very little, but growing rapidly. They didn't see the pregnancy the first time I had an ultrasound, the day I found out I was miscarrying, because it was too small to see. And now it was big.
I called Chase and told him all of that in about 2 minutes, barely able to speak. I was horrified, more scared than I think I have every been. He left work and immediately came to meet me at the cancer center at IMC, where they give the Methotrexate. He expressed concern; doesn't chemo hurt your future furtility? Does surgery sound like a better option? Then I called my dad. I rarely do anything medical without his recommendation first. Through tears I asked if I should let them give me the chemo. He tried to calm me down, but I could hear it in his voice. He doesn't get scared, and to him, nothing requires a doctor unless it's a really big deal, and he sounded nervous. He said, don't let them give you anything until I call you back. As I walked to the Cancer center I called Lauren, who knew I had an appointment that day. And I called my mom who offered to come down just as Chase arrived. We walked upstairs to the second floor of building three. They put me in a room, and right as the nurse walked in my dad called back. He had spoken with a trusted OBGYN friend of his who reiterated the same recommendations that Dr. Barton had given me. I later learned that my dad got emotional as he talked to his friend about my condition. I got the green light from Dad right as the nurse came in with a couple a big syringes. From the time that I spoke with Dr. Barton, to the time I was being injected with chemotherapy, was about one hour. And then I went back to work. That lasted 15 minutes, and I went home.
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