Erika's Story Part Two: If the Ectopic Isn't Fatal, It Will At the Very Least Kill Your Spirit

"Expired? Why would they courier over an expired vial of methotrexate?" My silent tears changed to sobs.

My RE wordlessly touched my shoulder and then left the room to check with his colleagues. Ten minutes later, he was back in the exam room with a look of relief. As luck would have it, another patient needed methotrexate earlier that day; while the universe had conspired against me, not allowing me to get even one dosage of methotrexate from the pharmacy, she had been given two. Her RE had the extra dose saved with a several other vials and boxes of donated meds and drug company samples, knowing it would be needed sooner or later.

So my RE used the clinic's extra methotrexate on the condition that I would return what I had gotten, get an unexpired bottle, and give it to the clinic as a swap. Could it have been any more complicated? (Actually, it was more complicated - but with some fate thrown in. After I got home and jumped on IVFConnections to commiserate with some of my friends, I learned that my methotrexate benefactor and fellow ectopic sufferer was one of my local thread buddies. It is a freakishly small world.)

My nurse drew the two injections from the vial. I eyed the syringes with sad eyes. "It needs to be split into two doses and given in two different locations," she said apologetically. "Sorry." Two injections were no big deal; after all, I had been shooting myself up in the belly and in the hip once a day for weeks. It was what was actually in the syringes that was shredding my heart. Inside me was a growing embryo - the very thing my husband and I had dreamed of since we got married. And the nurse was about to kill it. I know it wouldn't have survived, and that if left untreated it could cause serious problems (including my own death), but that didn't make me feel any better. Those may have been the facts, but the facts most definitely sucked.

I got my two injections and went home, sad and broken hearted. My husband did his best to cheer me up, but there was nothing he could do. I was so deeply withdrawn into myself that I didn't (couldn't?) even be there for his pain: he lost the baby, too.

A day later I began to bleed. "This is it," I thought. "My body is ending this pregnancy."

But I was wrong.

The bleeding continued for several days. After I had my next beta hCG drawn (to confirm that the numbers were going down like they were supposed to), the phone rang and I got the bad news.

"Your numbers are still going up," my nurse said. "We need to do another beta in two days. By then your numbers should be dropping. I'm sorry this isn't easy for you," she said quietly.

And two days later: "Not going up anymore. But not going down, either. We need to do a second dose of methotrexate, Erika."

Methotrexate, when drawn into the syringe, is an eerie yellowish color. It looks almost day-glow yellow, like a silent killer masquerading as Mountain Dew. That's all I could think about as I waited for the nurse to give me my second dose - two more syringes, two more stabs, two more reassurances that the embryo was no longer growing.

Two mornings after the second dose I was working at the oncology clinic that morning, glad to be busy. I really enjoyed spending time with my patients. I was finishing up the second-to-last batch clinical hours that I needed in order to obtain my advanced practice CNS (Clinical Nurse Specialist) license. I spent the day seeing patients every 20 minutes, so I had no time to mope around. Plus, most of my patients that day - as usual - were a hoot, keeping my mind off of my (in comparison) tiny little woes. Cancer is a horrific classification of diseases that does unspeakable things to bodies and lives. Yet it gives an unexpected gift: the disease causes people to transcend the typical bullshit in their lives, be genuine, and get quickly into deep relationship with others. Rarely have I had a patient who stayed a stranger to me for more than a visit or two; the nature of the disease strips away the barriers between two people, and the connections I made with my patients were unbelievable. There's nothing better than a nauseated, hairless, joke-cracking breast cancer fighter to put life into perspective for me. Oncology nursing always gave me so many reasons to be thankful - and that day was no exception.

That morning I slowly became aware of some abdominal discomfort. I didn't think much about it - I was still bleeding heavily and I assumed it was related. Around noon I had about a 60-minute break in the schedule, which gave me a chance to sit down and catch up on my charting before the afternoon rush. But when I sat down, instead of relief I felt more pain. I rode it out for two more hours before calling my RE's office. They wanted me to "stop by" so they could do a quick exam, and I was happy to comply -- the pain was enough that I started to panic.

I was taken into one of the empty exam rooms in the back of the office. Those rooms were typically used for IUIs or overflow patients; I guess since I was unscheduled and had to wait for my RE to catch a break, that was the best place to put me … although it felt a bit like they were stuffing the puffy-eyed, moaning woman far away from the rest of the patients!

I didn't wait long. My RE wheeled an ultrasound machine into the room and greeted me gently. "Let's take a look, see if we can see anything," he said. He moved the transvaginal ultrasound wand around and did his usual thorough exam, taking a look at all of the organs. Then he paused in one spot, staring at the screen. "Hmm."

"It looks like there is a mass right there, but I'm not positive. I'm going to get Dr. V's opinion. I'll be right back." My RE opened the exam room door and poked his head out; Dr. V happened to be standing nearby. "Can I get a consult, Dr. V?" he asked.

Dr. V walked in, greeted me in a quiet, warm voice and took a look at the ultrasound screen. Both doctors, at the same time, said, "Hmm." For a few minutes, they quietly talked to one another, taking measurements, looking in other places, asking each other questions and repeating "Hmm" at random intervals. Then my RE said, "there's a mass right here and I'm just not sure what it is." He pushed gently on my belly. "Does this hurt?"

I'm not sure if I said "yesssss" or "yaaaargh" but he got the message.

"I think we're seeing the products of conception, although they are not where I'd expect them. I know you're in pain and I want to help relieve that pain. I also do not want to take any chances, so I think we need to schedule a lap for later today. Whatever that is, it is inflamed and causing you pain, so we need to take a look and remove that mass. Do you agree with this assessment, Dr. V?"

Dr. V nodded and answered, "I agree; that's what I would do," before politely taking his leave and walking out the door.

"Let's get this scheduled for later today then," my RE said. "Can you call your husband?"

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The final part is still being written, but as soon as I'm done, I'll get it published. Thank you for all of the kind words of support that you've sent in email and private messages in the forums. One of the things that helped me through the whole ordeal was finding a blog post about someone else's ectopic. It gave me such insight into the process and if I hadn't read it, I would've been much more of a basket case than I was. So, if and when you need to read this, I really hope this helps you in some way. You aren't alone, and it's really a heartbreaking situation.