To be in the wrong place, of course, there has to be a right place. And maybe there is, and maybe there is not. For a pregnancy, sure, there is a right place, an only place, a special place where that single idea can take root and grow from idea to fetus and fetus to person. For a mother-to-be, the right place might be in her own city, her own country, on her own continent, but it also might not. For a child coming into the world it might be a hospital where the doctors speak the parents' language, or it might be the hospital closest to the parents' new home, where communication is limited to, "Pain? Fa male?" and a lot of pointing. There are degrees of rightness, and knowing which right is least wrong requires a clairvoyance that does not present in the majority of cases in the species to which the sound of the word wrong has meaning.
We were going to come to Rome a long time before the pregnancy test. Not long in terms of the way other people might plan to move to a different country, maybe, but long enough that we were pretty sure we weren't wrong. We were going to stay a year, so I made the decision to bring my cat and dog, which complicated things but seemed like the right thing to do. So the journey to Rome, which can be completed in less than a day of travel by human adults who are allowed and willing to use the airplane toilets, took us a week. We moved out of my apartment in Seattle into a hotel, and from there into a hotel in New York, and finally from there to a short-term apartment in Italy.
To bring live animals across international borders from the US in many cases requires the approval of the USDA. Approval must be given within ten days of entering the country so, with our break in New York, the best time for me to go to the USDA office in Olympia, Washington was the day before we left Seattle. I was a week late, but I'd taken one pregnancy test which turned out negative and had been chalking it up to stress. It took a long time at the USDA office and I was sitting in a small room alone, periodically going outside to smoke. It was my third cigarette in an hour and I thought that if somehow I was pregnant, if the first test had been wrong, that was definitely many more cigarettes than they like for pregnant women to smoke. So after I finally got my papers stamped I drove to the nearest pharmacy and took another over the counter test in their bathroom. It was positive. I was unsurprised, actually.
The first question was whether we should still go. But where else would we go? I'd turned in my keys. He'd moved out of his home in Scotland a month prior. Somewhat intentionally, we'd arranged things so that no one had a back-up plan, so that Rome could be the only plausible right place. A month before the pregnancy had been just a quiet egg sitting in a fallopian tube that had never previously been under suspicion of irregular cell turnover due to history of smoking, and Rome, having been decided upon and researched and studied for, was in actuality the most right place. The time was wrong, but we reasoned that the time was always a little bit wrong, for reasons ranging from total surprise to the anguish of month after month of lonely single lines on home pregnancy tests and still-tagged aspirational nursery furnishings gathering dust in a room never entered. We watched a lot of Judd Apatow movies and felt reassured of this.
So New York was much different than we'd planned. We didn't say goodbye to all the friends we'd meant to, we went out with one and our preoccupation and my conspicuous abstinence from my most visible vices made the whole thing a little stilted, so we didn't arrange any get-togethers after that. I bought prenatal vitamins and prenatal etiquette books and the most supportive sports bra they sell at REI and we reasoned that we could make it a couple weeks on common sense until we could sort out how to get some Italian health insurance. Once I learned I'd been right, I felt permitted to feel pregnant, and I did. In the course of days things changed quickly and I could definitely feel the pregnancy there. And then I couldn't.
I had no perceptible trouble with jetlag, since I was sleeping so much anyway. But once I truly woke up in Rome, sometime in the afternoon of the day after we landed, the symptoms had stopped increasing. My boobs hurt, but no worse than they had. I was tired, but not more than I'd been in New York. Instead of having to pee more frequently, I seemed able to hold it longer and longer. We got to work on looking for a permanent apartment, topping up dormant prepaid Italian SIMs, and of course on finding un ostetrico che parla inglese. We arrived on Wednesday and, after going more or less door-to-door between hospitals, were able to book an appointment for the following Monday.
The fact of our hubris only struck me as we sat in the doctor's office, trying to convey in a broken combination of English and Italian 101 that we weren't just on a visit but were planning to stay a year, and hadn't had an initial appointment to confirm the pregnancy before leaving the United States. She pronounced me seven weeks pregnant and led me into a small closet next to her office with an examination table, stirrups at the ready. Without the series of hesitations for modesty you'd expect in American medicine, she had me strip and mount up, then began to poke around my pelvis from various angles. She'd said in the office I'd go downstairs for an ultrasound, and so it surprised me when she fired up a small machine in the corner and wordlessly began a transvaginal ultrasound. She turned the screen to face me, showing me an empty uterus, and told me I was not pregnant. I was unsurprised, actually. She sent me downstairs for a blood test to confirm. The nurse spoke no English, but was highly skilled. I felt nothing.
Later that day she called with the results of the blood test. The levels of the hormone human chorionic gonadotropin (hCG) in my body suggested a pregnancy two to four weeks old. She told me either the pregnancy was too early to detect, or it was ectopic. We looked at a calendar and counted backward and figured it was not too early. It was a seven-week-old pregnancy with something wrong with it. The fear I'd been suppressing for five days or so had been well-founded: we would lose the baby, there had never been any hope of a baby, the egg had grown into an idea and died somewhere on the precipice of becoming a fetus.
A flowchart of diagnosis of any female patient of child-bearing age presenting with no evidence of intrauterine pregnancy and lower levels of hCG than expected based on fetal age indicates that, absent any pain or bleeding, the best thing to do is wait 48 hours and check those diagnostic factors again. I know this because my sister studies epidemiology and was able to send me a link to a paper on the subject. All I was able to work out over the phone with the doctor was that in two days time I would have a second appointment.
We didn't make it. On Wednesday morning at 3am I woke to cramps and bleeding, freezing and scared. I hadn't read yet that ectopic pregnancy is the leading cause of maternal death, or that a ruptured fallopian tube unable to accommodate the pressure of an amniotic sac growing larger in the wrong place can lead to internal bleeding that has to be addressed quickly if any lives at all are going to be saved. We'd never completely figured out that Italian health insurance, and at 3am it seemed my odds of getting an English-speaking ER doctor weren't good, so I decided it was best to try and sleep and call the doctor I had already in the morning. Luckily, in the morning I woke up.
At the hospital, I explained that I was having a miscarriage. I hid my face in my fiancé's shoulder and sobbed while the receptionist tried to find someone in Italian and the cramps continued. In a different dark closet a different doctor in scrubs gave me another ultrasound, this one prepared hastily, the extra digits of a hospital glove dangling off it like the hand of some rich Valium-soaked vampire ordering a fresh napkin. It hurt. Everything hurt. I couldn't separate the pain of the cramps from the brusque prodding of the ultrasound wand from the ache in the soles of my feet. "Ectopica," she nodded.
They sent me downstairs for another blood test. Outside, afterward, I found the doctor talking to my fiancé. She wanted to keep me for 24 hours, she explained, and I would see my original doctor at 2. I was confused, I thought, having not been "rushed into" some imagined TV version of "surgery" once I arrived, that I'd have the tests again and be sent home. "For observation only," she assured me. I wasn't sure of the danger if I refused, so I said yes. She led me to a desk to check in. The administrative employee I purchased the room from spoke the best English I encountered in the hospital, but unfortunately could not give me medical advice.
Things happened vey quickly before they stopped. In the elevator the admin woman said, "I'm sorry, we have to give you a room on the maternity floor." We walked past closed doors with pink and blue hearts and I bit my tears and wished there'd been a bed elsewhere. Then a moment later I was being quizzed about the whereabouts of my pajamas (they were still in the wrong country) while three women tried with a series of vicious stabs to find a vein my arm for the IV. Male. Ero spaventato. But the IV was full of some kind of painkiller and they found a hospital gown and then they all left and we were alone. When the doctor arrived, she said the same things again. Ectopic. More tests. Observation. We guessed at what sort of things you need overnight in a hospital and he left to get them and it was just me, drugs dripping into my arm, in completely the wrong place.
I thought again about hubris, and how foolish I'd been to think I could just move to Rome or just have a baby or just go to the hospital and have everything made better, and how cruel fate can be when you leave it no choice but to put you back in your place.
Yesterday they sent me home, my 24 hours elapsed. The only answer they gave me was an ultrasound image showing what might be a lump from what might have been a baby if things had worked out differently, and an appointment in 48 hours for more tests. It may be over by the next blood test. Or it may turn out that a fallopian tube, which only has one right place, is in my case in the wrong one. The right one may be a medical waste bin, now. It's funny. The wrong place can be a lot of things.