For When Times Are Tough

I've talked in previous posts (Missed Miscarriage, Yellow Nursery Stripes, April 19, From August to August) about the healing process I went through after my miscarriage - facing the grief and finding the strength to try it all again in pursuit of my dreams.

One thing I did was spend a lot of time finding and compiling facts and quotations I found personally helpful. I started with encouraging statistics and uplifting sentiments that were miscarriage-specific, but as I felt emotionally stronger, my document quickly evolved into one filled with more generic advice - something I thought I might be able to refer to again, for any number of losses (deaths, relationships, career choices, self-doubt, etc.), whenever the inevitable next one happened in my life.

Finding these quotations and organizing them into a love letter of sorts/a how-to guide for myself was very therapeutic for me (and admittedly a very "Ravenclaw" thing to do, so I realize it's not everyone's cup of tea...) It was also likely the process of creating the list, more than the actual content, which helped me most, since it necessitated spending time self-reflecting and prioritizing my mental health. I don't know if I actually will refer to this list again in the future; I might compile an entirely new list instead.

Still, I thought I would share some of the quotations I found (and the structure I organized them into), in case this might help anyone else, too. When I find it hard to accept my own thoughts or truly believe my own words, reading the words that others have written can be wonderfully affirming and invaluable.

An abridged version of the document I created is below. (And yes, the full document I wrote - and am still adding to, whenever I find more quotes that speak to me - really is even longer than this!) :)

***

You're allowed to feel the way you feel. You are allowed to grieve for things you've lost. First, you need to give yourself that time.

Then, when the grief is no longer all-consuming, read this letter to remind yourself that you are also allowed to romanticize, reframe, and transform your pain. You do not have to keep living in it.

Some of these sentiments contradict each others; still others are at least occasionally untrue. They may be things you want to believe, but have trouble actually believing. On days when you are determined to get in the way of your own happiness, that may seem like enough reason to reject them. But remember: something does not have to be an absolute truth to be beneficial.

"You're going to live your life based on delusions (and you are, because we all do)... Why not at least select a delusion that is helpful?" (Elizabeth Gilbert - Big Magic: Creative Living Beyond Fear)

Think of this not as a list of truths, but as a list of useful delusions. And if that is not enough - if at any time your grief returns or you don't have it in you to forge continuously ahead - you are allowed to take a step back and grieve all over again. Grief is not linear. The words below will not always give you comfort. But in those moments when you're healed enough to hear them, they are here for you.

"The time to repair the roof is when the sun is shining." (John F. Kennedy)

This letter is your roof, and you have prepared it so it will be there for you when next it rains. Use it. May these words inspire you, and may its compilation remind you of your foresight and strength. You have outlived grief in the past, and you will outlive it again.

*

Dear Andrea,

Times are tough right now - so tough that you may want nothing more than to deny it or move quickly past it. But first you need to make sure you've allowed yourself to truly feel your grief. Name it. Analyze it. Confront it. Write about it.

• "Numbing the pain for awhile will make it worse when you finally feel it." (J.K. Rowling - Harry Potter and the Goblet of Fire)
• "Of all the things in the world, suffering is the most real. You can never ignore it or doubt it." (Yuval Noah Harari - 21 Lessons for the 21st Century)
• "Research has found that the act of not discussing a traumatic event or confiding it to another person can be more damaging than the actual event... Writing about traumatic experience can produce measurable changes in physical and mental health." (Brene Brown - Daring Greatly)
• "To survive something we first need to know what it is we're surviving." (Miriam Toews - All My Puny Sorrows)

To be human is to grieve, and for better or worse, you are a part of the web of humanity.

• "Every human requires food and water to survive and every human has a heart that bleeds, loves, and grieves." (Suzy Kassem - Rise Up and Salute the Sun)
• "Life isn't pretty / We all get a little wrecked sometimes." (The Veronicas - On Your Side)
• "You are allowed to feel messed up and inside out. It doesn't mean you're defective - it just means you're human." (David Mitchell - Cloud Atlas)
• "Life is a series of losses... We're all terminal." (Kate Bowler - Everything Happens for a Reason: And Other Lies I've Loved)
• "There's always gonna be another mountain / I'm always gonna wanna make it move / Always gonna be an uphill battle / Sometimes I'm gonna have to lose" (Miley Cyrus - The Climb)
• "It if don't hurt now, just wait, just wait awhile / Ain't in fun / Living in the real world" (Paramore - Ain't It Fun)

Life is, at times, inexplicably and inescapably awful. The bad and good in life are permanently tied up in each other. Uncleavable.

• "I've made some friends, and I've lost some too." (Andrew McMahon - Cecilia and the Satellites)
• "You know time will give and time will take." (Phillip Phillips - Raging Fire)
• "I can't reconcile the way that the world is jolted by events that are wonderful and terrible, the gorgeous and the tragic. Except that I am beginning to believe that these opportunities do not cancel each other out. Life is so beautiful. Life is so hard." (Kate Bowler - Everything Happens for a Reason: And Other Lies I've Loved)

You did nothing to deserve this pain. You did nothing wrong. In fact - you're doing everything right. You're hurt right now because in trying to experience all the good that life has to offer, you also stumbled upon the bad. You lost because you were brave enough to try to win.

• "Now we're falling through the ice / We made our bed and rolled the dice / Well every gamble has a price." (Banners - Empires on Fire)
• "Everybody tries to put some love on the line / And everybody feels a broken heart sometimes." (Teddy Geiger - These Walls)
• "The sorrow we feel when we lose a loved one is the price we pay to have had them in our lives." (Rob Liano)
• "What are you passionate enough about that you can endure the most disagreeable aspects of it?" (Elizabeth Gilbert - Big Magic: Creative Living Beyond Fear)

When you love someone or something, you make yourself vulnerable to loss.

• "The course of true love never did run smooth." (William Shakespeare - A Midsummer Night's Dream)
• "Love is uncertain. It is incredibly risky. And loving someone leaves us emotionally exposed." (Brene Brown - Daring Greatly)
• "Where there is desire, there is gonna be a flame / Where there is a flame, someone's bound to get burned." (Pink - Try)
• "I find it bittersweet / 'Cause you gave me something to lose / If you love someone and you're not afraid to lose 'em / You'll probably never love someone like I do." (Lukas Graham - Love Someone)
• "He who loves 50 people has 50 woes; he who loves no one has no woes." (Buddha)
• "Here's the truth: Who is spared love is spared grief." (David Mitchell - Bone Clocks)

But that is no reason not to love, or live.

• "Vulnerability is the core, the heart, the center of meaningful human experiences... To foreclose on our emotional life out of a fear that the costs will be too high is to walk away from the very thing that gives purpose and meaning to living... Living without connections - without knowing love and belonging - is not victory." (Brene Brown - Daring Greatly)
• "When we were children, we used to think that when we were grown up we would no longer be vulnerable. But to grow up is to accept vulnerability. To be alive is to be vulnerable." (Madeleine L'Engle)
• "Love doesn't discriminate / Between the sinners and the saints / It takes and it takes and it takes / And we keep loving anyway... Death doesn't discriminate / Between the sinners and the saints / It takes and it takes and it takes / And we keep living anyway" (Hamilton Soundtrack -Wait for It)
• "Hope that you fall in love / And it hurts so bad / The only way you can know / You gave it all you had." (One Republic - I Lived)
• "If this love is pain, well darling, let's hurt tonight." (One Republic - Let's Hurt Tonight)

If we try to avoid the bad, we will fail to experience any of the good. There is nothing to do but lean in and embrace it all.

• "The world is an ugly place. We must live in it." (Madeline Miller - Circe)
• "If you hide under the covers / You might never see the light of day" (Mary Poppins Returns - Trip a Little Light Fantastic)
• "Numbing vulnerability doesn't just deaden the pain of our difficult experiences; numbing vulnerability also dulls our experiences of love, joy, belonging, creativity, and empathy. We can't selectively numb emotion. Numb the dark and you numb the light." (Brene Brown - Daring Greatly)
• "Action may not always bring happiness, but there is no happiness without action." (Benjamin Disraeli)
• "You are here to risk your heart. You are here to be swallowed up. And when it happens that you are broken, or betrayed, or left, or hurt, or death brushes near, let yourself sit by an apple tree and listen to the apples falling all around you in heaps, wasting their sweetness. Tell yourself you tasted as many as you could." (Louise Erdrich - The Painted Drum)

Practice fearlessness - even when you're afraid.

• "Even when I'm scared I have to try to fly / Sometimes I fall / But I've seen it done before / I gotta step outside these walls" (Teddy Geiger - These Walls)
• "If the highest aim of a captain were to preserve his ship, he would keep it in port forever." (Thomas Aquinas)
• "You have plenty of courage. All you need is confidence in yourself. There is no living thing that is not afraid when it faces danger. The true courage is in facing danger when you are afraid." (L. Frank Baum - The Wonderful Wizard of Oz)
• "I wanted you to see what real courage is. It's when you're licked before you begin, but you begin anyway and see it through no matter what." (Harper Lee - To Kill a Mockingbird)
• "Living a life that is driven more strongly by curiosity than by fear... You have to be willing to take risks if you want to live a creative existence." (Elizabeth Gilbert - Big Magic: Creative Living Beyond Fear)
• "May your choices reflect your hopes, not your fears." (Nelson Mandela)

We can't choose what happens to us when we try. But we can choose to try anyway. And the act of making that choice both forges and proves our inner strength.

• "There are only two mistakes one can make: not going all the way, and not starting." (Buddha)
• "I am not what has happened to me. I am what I choose to become." (Carl Jung)
• "Vulnerability is not weakness, and the uncertainty, risk, and emotional exposure we face every day are not optional. Our only choice is a question of engagement. Our willingness to own and engage with our vulnerability determines the depth of our courage and the clarity of our purpose." (Brene Brown - Daring Greatly)
• "It was the difference between being dragged into the area to face a battle to the death and walking into the arena with your head held high. Some people, perhaps, would say that there was little to choose between the two ways, but... there was all the difference in the world." (J.K. Rowling - Harry Potter and the Half-Blood Prince)
• "The credit belongs to the man who is actually in the arena... who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly." (Theodore Roosevelt)

Picking yourself up and trying again is a choice you may have to make over and over again. But you can, and you will.

• "Just because it burns doesn't mean you're gonna die / You gotta get up and try, try, try" (Pink - Try)
• "Being defeated is often a temporary condition. Giving up is what makes it permanent." (Marilyn vos Savant)
• "You may have to fight a battle more than once to win it." (Margaret Thatcher)
• "This is how things go. You fix them, and they go awry, and then you fix them again." (Madeline Miller - Circe)
• "It was important to fight, and fight again, and keep fighting, for only then could evil be kept at bay, though never quite eradicated." (J.K. Rowling - Harry Potter and the Half-Blood Prince)
• "Our greatest glory is not in never failing, but in rising every time we fall." (Confucius)
• "I'll rise up / High like the waves / I'll rise up / In spite of the ache / I'll rise up / And I'll do it a thousand times again." (Andra Day - Rise Up)

You will glean wisdom from this pain. It will grow you and deepen you.

• "Experience is the only thing that brings knowledge and the longer you are on earth the more experiences you are sure to get." (L. Frank Baum - The Wonderful Wizard of Oz)
• "Biology gives you a brain. Life turns it into a mind." (Jeffrey Eugenides - Middlesex)
• "It matters not what someone is born, but what they grow to be." (J.K. Rowling - Harry Potter and the Goblet of Fire)
• "People who only have good experiences aren't very interesting. They may be content, and happy after a fashion, but they aren't very deep." (Peter Cameron - Someday This Pain Will Be Useful to You)
• "The goal is not getting comfortable, but normalizing discomfort. We need to cultivate the courage to be uncomfortable and to teach people around us how to accept discomfort as a part of growth." (Brene Brown - Daring Greatly)
• "Don't give in / Don't you dare quit so easy / There is a lot we can learn from this loss" (Snow Patrol - Don't Give In)
• "It's times like these you learn to live again / It's times like these you give and give again / It's times like these / Time and time again" (Foo Fighters - Times Like These)

Suffering brings enlightenment and empathy.

• "The wound is the place where the Light enters you." (Rumi)
• "I had to go through hell to prove I'm not insane / Had to meet the devil just to know his name." (Ella Henderson - Ghost)
• "Vulnerability is the birthplace of love, belonging, joy, courage, and creativity. It is the source of hope, empathy, accountability, and authenticity. If we want greater clarity of our purpose or deeper or more meaningful spiritual lives, vulnerability is the path. (Brene Brown - Daring Greatly)
• "There is no shame in what you are feeling. On the contrary, the fact that you can feel pain like this is your greatest strength." (J.K. Rowling - Harry Potter and the Order of the Phoenix)
• "My own suffering began to feel like it had revealed to me the suffering of others, a world of those who, like me, are stumbling in the debris of dreams they thought they were entitled to and plans they didn't realize they had made." (Kate Bowler - Everything Happens For a Reason: And Other Lies I've Loved)
• "The pain sculpts us into someone who understands more deeply, hurts more often, appreciates more quickly, cries more easily, hopes more desperately, and loves more openly." (Unknown)
• "In order to act morally...you need to develop a deep appreciation of suffering... And if you want to know the truth of the universe, about the meaning of life, and about your own identity, the best place to start is by observing suffering and exploring what it is." (Yuval Noah Harari - 21 Lessons for the 21st Century)
• "Compassion is not a relationship between the healer and the wounded. It's a relationship between equals. Only when we know our own darkness well can we be present with the darkness of others." (Pema Chodron)

You are a block of marble, and pain is the chisel gradually shaping you into the masterpiece that you are. It's good that difficult times are inevitable - because they are also useful.

• "Under this pressure, under this weight / We are diamonds taking shape" (Coldplay - Adventure of a Lifetime)
• "Grief does not change you. It reveals you." (John Green - The Fault in Our Stars)
• "Even if I could [erase your scars], I wouldn't. Scars can come in handy. I have one myself above my left knee that is a perfect map of the London Underground." (J.K. Rowling - Harry Potter and the Sorcerer's Stone)
• "The scars themselves I offered to wipe away. He shook his head. 'How would I know myself?' They suited him. Whoever saw him must salute and say: There is a man who has seen the world. There is a captain with stories to tell." (Madeline Miller - Circe)
• "I am brave, I am bruised / I am who I'm meant to be / This is me." (Keala Settle, The Greatest Showman Soundtrack - This is Me)

Life is built from pain; so use your pain to build the life you desire. Treat this experience as nourishment for your soul and the spark that can light your creative projects.

• "The winter's cold / But the snow still lightly settles on the trees / And a mess is still a moment I can seize" (Gabe Dixon Band - All Will Be Well)
• "You're going to go through tough times - that's life. But I say, 'Nothing happens to you, it happens for you.' See the positive in negative events." (Joel Osteen)
• "I cannot bear this world a moment longer... Then child, make another." (Madeline Miller - Circe)
• "The opposite of war isn't peace... It's creation!" (Rent Soundtrack - La Vie Boheme)
• "Grief needs an outlet. Creativity offers one." (Hope Edelman)
• "Artists crave experiences because that's how they make art." (Whitney Scharer - The Age of Light)
• "Pick up a pen, start writing / I wanna talk about what I have learned / The hard-won wisdom I have earned." (Hamilton Soundtrack - One Last Time)

There is a time in every compelling narrative when things get difficult. Without conflict to overcome, there is no story. It is not easy - but it is worth it.

• "There was only one way to the other side, and that was through the pain." (Vanessa Diffenbaugh - The Language of Flowers)
• "The harder the struggle, the more glorious the triumph." (Unknown)
• "Such narrative arcs make good movies but shitty existences." (David Mitchell - Bone Clocks)
• "I guess the bad can get better / Gotta be wrong before it's right / But still the growing pains, growing pains are keeping me up at night" (Alessia Cara - Growing Pains)
• "You have set yourselves a difficult task, but you will succeed if you persevere; and you will find a joy in overcoming obstacles. Remember, no effort that we make to attain something beautiful is ever lost." (Helen Keller)

Challenging times are opportunities to remind yourself what you're made of, and chances to grow further evidence of your tenacity and success.

• "When we meet real tragedy in life, we can react in two ways - either by losing hope and falling into self-destructive habits, or by using the challenge to find our inner strength." (Dalai Lama)
• "Grief and resilience live together." (Michelle Obama - Becoming)
• "What does not destroy me makes me stronger." (Friedrich Nietzsche)
• "Do not confuse my bad days as a sign of weakness. Those are the days I am actually fighting my hardest." (Unknown)
• "Experience gives us the advantage of knowing that we can survive the exposure and uncertainty, and that it's worth the risk." (Brene Brown - Daring Greatly)
• "You can take everything I have / You can take everything I am / Like I'm made of glass, like I'm made of paper / Go on and try to tear me down / I will keep rising from the ground / Like a skyscraper" (Demi Lovato - Skyscraper)

In the future, you will cherish the memories of this experience, and draw on them for comfort and strength.

• "Give it all or give it up / I won't settle for enough / It's the highs and it's the lows we remember" (Ocean Park Standoff - Good News)
• "There will be a sea of tears / But sooner or later the sea will dry up / And you'll learn to embrace the wet sand revealed." (Sanhita Baruah)
• "One day in retrospect, the years of struggle will strike you as the most beautiful." (Sigmund Freud)
• "Someday you're gonna look back on this moment of your life as such a sweet time of grieving. You'll see that you were in mourning and your heart was broken, but your life was changing." (Elizabeth Gilbert)

Your narrative is your own narrative, and it will follow its own timeline.

• "There is purpose in your season of waiting." (Megan Smalley)
• "Time is a force and we must allow it to do its work, must respect its power." (Miriam Toews - All My Puny Sorrows)
• "Anxiety happens when you think you have to figure out everything all at once. Breathe. You're strong. You got this. Take it day by day." (Karen Salmansohn)
• "If we walk far enough, we shall sometime come to someplace." (L. Frank Baum - The Wonderful Wizard of Oz)
• "Don't rush through the experiences and circumstances that have the most capacity to transform you." (Rob Bell)

Don't worry about what future bad things might happen.

• "Contemplating the task ahead would not make it easier." (J.K. Rowling - Harry Potter and the Deathly Hallows)
• "I don't think being frightened will help." (Madeline Miller - Circe)
• "Worry does not take away tomorrow's troubles. It takes away today's peace." (Randy Armstrong)
• "No good sittin' worryin' about it. What's comin' will come, an' we'll meet it when it does." (J.K. Rowling - Harry Potter and the Goblet of Fire)

Don't wallow in what would've-could've-should've been, either.

• "Nostalgia is a dangerous form of comparison." (Brene Brown - Daring Greatly)
• "You're holding on to what you never had" (Hailee Steinfeld - Let Go)
• "Don't fall in love with the way things were / It'll fuck up your mind" (Snow Patrol - Don't Give In)
• "Leave the past behind you. If you don't leave it there, it clutters everything up and you just keep tripping over it." (Laini Taylor - Muse of Nightmares)
• "May your past be the sound / Of your feet upon the ground / And carry on" (Fun. - Carry On)

Focus instead on the vast potential of your present and future - the things that are still changeable, the successes and joys you've yet to see. Allow yourself to be happy and optimistic. Allow yourself to hope and dream and want things.

• "Yesterday is not ours to recover, but tomorrow is ours to win or lose." (Lyndon B. Johnson)
• "It is as wrong to deny the possible as it is to deny the problem." (Dr. Dennis Saleebey)
• "We must have the stubbornness to accept our gladness in the ruthless furnace of this world." (Jack Gilbert)
• "You'll never find a rainbow if you're looking down." (Charlie Chaplin)
• "We are all in the gutter, but some of us are looking at the stars." (Oscar Wilde)
• "Happiness can be found, even in the darkest of times, if one only remembers to turn on the light." (J.K. Rowling - Harry Potter and the Prisoner of Azkaban)
• "The world unwraps itself to you, again and again as soon as you are ready to see it anew." (Gregory Maguire - Wicked)

Allow yourself to try again - to throw yourself back into the fray, to make new plans and follow through on them.

• "It does not do to dwell on dreams and forget to live." (J.K. Rowling - Harry Potter and the Sorcerer's Stone)
• "Life won't just happen to you. You have to happen to it." (Laini Taylor - Strange the Dreamer)
• "Hope is a combination of setting goals, having the tenacity and perseverance to pursue them, and believing in our own abilities." (Brene Brown - Daring Greatly)
• "Wishes don't just come true. They're only the target you paint around what you want. You still have to hit the bull's-eye yourself." (Laini Taylor - Muse of Nightmares)

Life doles out enough grief without you willfully adding more as a form of self-punishment. You don't have to wallow in it and invite it to prolong its stay in your heart.

• "I keep dragging around what's bringing me down / If I just let go, I'd be set free" (Linkin Park/Kiiara - Heavy)
• "All the broken hearts in the world still beat / Let's not make it harder than it has to be" (Ingrid Michaelson - Girls Chase Boys)
• "All my life had been murk and depths, but I was not a part of that dark water. I was a creature within it." (Madeline Miller - Circe)
• "I'd been stoking the most negative parts of myself, caught up in the notion that everything was unfair and then assiduously, like a Harvard-trained lawyer, collecting evidence to feed that hypothesis. I now tried out a new hypothesis: It was possible that I was more in charge of my happiness than I was allowing myself to be." (Michelle Obama - Becoming)
• "Our creativity grows like sidewalk weeds out of the cracks between our pathologies - not from the pathologies themselves... I refuse to seek out suffering in the name of artistic authenticity." (Elizabeth Gilbert - Big Magic: Creative Living Beyond Fear)

Don't let hopelessness catch you in its spiral, telling you that where you are now is where you will remain forever. This is a self-fulling prophecy, a trap - and to believe such absolutes is a form of arrogance. You do not know what is to come.

• "Please keep in mind that whatever you're going through, this challenging time in your life is merely IN your life. It is not your whole life. So be sure to keep this slice of life in perspective and don't let it overwhelm you. Remember: nothing is everything. The part is not greater than the whole." (Karen Salmansohn)
• "Tone down the prophecies of doom and switch from panic mode to bewilderment. Panic is a form of hubris. It comes from the smug feeling that one knows exactly where the world is heading: down. Bewilderment is more humble and therefore more clear-sighted... Try telling yourself, 'Truth is, I just don't understand what's going on.'" (Yuval Noah Harari - 21 Lessons for the 21st Century)
• "Doubt kills more dreams than failure ever will." (Suzy Kassem)
• "Just because something isn't happening for you right now doesn't mean that it will never happen." (Unknown)
• "In this sad world of ours sorrow comes to all and it often comes with bitter agony. You may believe that you will never feel better. But this is not true. You are sure to be happy again." (Abraham Lincoln)

It is often easier to fall for that trap of depression than it is to remain hopeful - but just because something is easy does not mean it is the best course.

• "There will be a time when we must choose between what is easy and what is right." (J.K. Rowling - Harry Potter and the Goblet of Fire)
• "He had been broken and reassembled as a shell, only then to do the bravest thing of all: He had kept on living, though there are easier paths to take." (Laini Taylor - Strange the Dreamer)
• "Dying is easy - living is harder" (Hamilton Soundtrack - Right Hand Man)
• "We must try not to sink beneath our anguish, but battle on." (J.K. Rowling - Harry Potter and the Half-Blood Prince)
• "Don't squander joy. We can't prepare for tragedy and loss. When we turn every opportunity to feel joy into a test drive for despair, we actually diminish our resilience. Every time we allow ourselves to lean into joy and give in to those moments, we build resilience and we cultivate hope." (Brene Brown - Daring Greatly)
• "Healing takes courage, and we all have courage, even if we have to dig a little to find it." (Tori Amos)

Faith is fuel, keeping you moving through long stretches of desert. Belief in the future, in a light you cannot see, is not foolishness, but bravery.

• "You don't have to see the whole staircase. Just take the first step." (Martin Luther King, Jr.)
• "You need a leap of faith to leave your old life behind. True metamorphosis doesn't come with flowcharts." (David Mitchell - Bone Clocks)
• "That's what faith is, isn't it? Following the music when we don't hear it." (Francisco X. Stork - Marcelo in the Real World)

Believe in yourself. Forgive yourself. Be kind to yourself.

• "Never apologize, never explain it away, never be ashamed of it. You did your best with what you knew, and you worked with what you had, in the time that you were given." (Elizabeth Gilbert - Big Magic: Creative Living Beyond Fear)
• "Cultivate the courage to be imperfect and self-compassionate. Perfectionism is not the path that leads us to our gifts and to our sense of purpose; it is a hazardous detour... Our worthiness, that core belief that we are enough, comes only when we own our stories (even the messy ones)." (Brene Brown - Daring Greatly)
• "Even when it's not pretty or perfect. Even when it's more real than you want it to be. Your story is what you have, what you will always have. It is something to own." (Michelle Obama - Becoming)
• "We have to be willing to give ourselves a break and appreciate the beauty of our cracks and imperfections. To be kinder and gentler with ourselves and each other. To talk to ourselves the same way we'd talk to someone we care about." (Brene Brown - Daring Greatly)
• "You, yourself, as much as anybody in the entire universe, deserve your love and affection." (Buddha)

There are things that are going to be outside your control. Understanding that is not an admission of failure, but an important step toward acceptance.

• "Control is a drug, and we are all hooked, whether or not we truly believe that we can master the future with our words and attitudes. The entire motivational-speaking industry rests on the assumption that you can have what you want, you can be what you want... [and that] there is a hidden logic to this seeming chaos... [But] nothing human or divine will map out this life, this life that has been more painful than I could have imagined. More beautiful than I could have imagined." (Kate Bowler - Everything Happens for a Reason: And Other Lies I've Loved)
• "Someday it might make sense to you - why you needed to go through this botched-up mess in order to land in a better place. Or maybe it will never make sense. So be it. Move on anyway." (Elizabeth Gilbert - Big Magic: Creative Living Beyond Fear)
• "'It is not fair' and 'It cannot be' are two different things." (Madeline Miller - Circe)
• "Fairness is one of the most compelling claims of the American Dream, a vision of success propelled by hard work, determination, and maybe the occasional pair of bootstraps... In a world of fair, nothing clung to can ever slip away... Give up that little piece of the American Dream that says 'You are limitless'. Everything is not possible." (Kate Bowler - Everything Happens for a Reason: And Other Lies I've Loved)

But just because some things are uncontrollable does not mean everything is. Control what you can. Even when you are swimming in uncertainty, there is always something you can do. You can try to enjoy today.

• "We are never so wise as when we live in this moment." (Paul Kalanithi - When Breath Becomes Air)
• "Do not save this for tomorrow / Embrace the past and you can live for now / This is the new year / A new beginning" (A Great Big World - This is the New Year)
• "There's only now / There's only here/ Give in to love / Or live in fear / No other path / No other way / No day but today" (Rent Soundtrack - Another Day)

Be grateful for where you are right now. If your lungs are still breathing, your heart still beating, you have at least two things to marvel at.

• "A rainy day is better than no day." (Rachel Simon - The Story of Beautiful Girl)
• "Even if I'm dying, until I actually die, I am still living." (Paul Kalanithi - When Breath Becomes Air)
• "Live unburdened. Live free. Live without forevers that don't always come... The water is rising and levees may break and it will sweep us all away. But until then, I am here." (Kate Bowler - Everything Happens for a Reason: And Other Lies I've Loved)
• "Look around, look around at how lucky we are to be alive right now / Look at where you are / Look at where you started / The fact that you're alive is a miracle / Just stay alive, that would be enough" (Hamilton Soundtrack - That Would Be Enough)
• "Aging is a fucking privilege." (Kate Bowler - Everything Happens for a Reason: And Other Lies I've Loved)
• "It doesn't mean that it does not hurt. It doesn't mean that we are not frightened. Only that: we are here. This is what it means to swim in the tide, to walk the earth and feel it touch your feet. This is what it means to be alive." (Madeline Miller - Circe)

Remember: if the bad and good are permanently tied up in each other, that means good times are also inevitable. Good times are coming. You will get through this. This too shall pass.

• "If life didn't change, it wouldn't be life, it'd be a photograph." (David Mitchell - Bone Clocks)
• "Even the darkest night will end and the sun will rise." (Victor Hugo)
• "It's been a long cold lonely winter / It feels like years since it's been here... Here comes the sun / Here comes the sun, and I say / It's alright" (The Beatles - Here Comes the Sun)
• "All will be well / You can ask me how but only time will tell" (Gabe Dixon Band - All Will Be Well)
• "This feeling will pass. This workload will pass. These people will pass. This moment will pass. This fatigue will pass." (Lin-Manuel Miranda - Gmorning Gnight)
• "It's funny how some distance makes everything seem small / And the fears that once controlled me can't get to me at all" (Frozen Soundtrack - Let it Go)
• "Pain will come with time, but time will heal the pain." (Anthony Liccione)

Letting go of the comfort of grieving can be difficult. But you are capable of accomplishing this final hurdle in moving on. Just because something is gone does not mean it will be forgotten.

• "I wanna let go but there's comfort in the panic" (Linkin Park/Kiiara - Heavy)
• "The brain is built to forget things as we continue to live; memories are meant to fade and disintegrate and sharp edges become blunt; the pain of letting go of grief is just as painful or even more painful than the grief itself. It means goodbye." (Miriam Toews - All My Puny Sorrows)
• "This is what I know about loss: It doesn't get better. You just get (somewhat) used to it." (Jennifer Niven - Holding Up the Universe)
• "You think the dead we loved ever truly leave us? You think that we don't recall them more clearly in times of great trouble?" (J.K. Rowling - Harry Potter and the Prisoner of Azkaban)
• "Nothing's really left or loss without a trace / Nothing's gone forever - only out of place... Maybe all you're missing lives inside of you" (Mary Poppins Returns - Where Lost Things Go)

I love you and I believe in you.

Love, Andrea

Pattern Chesney in Pink and Red

"Pattern Chesney in Pink and Red" is another 8x10" patterned watercolor painting I recently completed.

As usual, I started by tracing one of my personally designed patterns (created in Adobe Illustrator) onto watercolor paper in pencil. Then I taped down the paper to hold it flat while I painted, selected my paint tubes, and got to work!

Here is the start of the process, going back and forth between the pink and red watercolor pigments to paint each shape in between the white pattern. The white pattern that remains is the color of the unpainted paper.

Getting closer! This painting is now about 3/4 complete.

And here's the finished painting - first while it was still taped down and drying, and then once it was completely dry and untaped, with any remaining pencil marks erased.

This particular painting is not yet listed for sale on Etsy, but in the meantime, check out the several watercolor sets of patterned paintings I do have in my Etsy shop - framed and ready to hang!

Pattern Kiara in Olive Green and Blue

I recently painted several 8"x10" patterned watercolors, and today I'd like to show you the in-progress (and finished!) pics of "Pattern Kiara in Olive Green and Blue."

First, as usual, I traced the pattern onto watercolor paper with pencil. This pattern is one of literally thousands that I've designed over the last several years in Adobe Illustrator.

I taped the drawing down onto the table, to keep it flat while I painted, and selected the two colors of Daniel Smith brand watercolors paints I'd be using - olive green and blue.

Then I started painting with a small brush, careful not to paint the parts of the pattern that I wanted to keep white. I worked through the whole painting this way. (In some of the pictures below, you can see which ares of paint were still wet when I took the photo.)

And here's the finished painting, still taped down while it finishes drying!

Once fully dry, I untaped it, matted it, and photographed the finished piece.

This particular painting is not yet listed for sale on Etsy, but in the meantime, check out the several watercolor sets of patterned paintings I do have in my Etsy shop - framed and ready to hang!

Summer Flowers

In spring, my front yard blooms with tulips. In summer, it blooms with lilies!

The north side of our house also has some beautiful landscaping now - ferns, astilbe, and hosta. Below is a shot of the pink astilbe shoots, as well as an early hosta bud, taken in July.

My front yard also has 3 hydrangea bushes - two small ones and one giant one, which is now too tall for me to trim! The tallest one doesn't bloom until the fall, but these two little ones started showing their flowers in July.

I love being able to take pictures of flowers without even having to leave my property! :)

Diabetes & Pregnancy: The 1st Trimester

*Disclaimer: Obviously this is not intended as medical advice. I'm not a doctor. Everyone is different, and will have different requirements both for their diabetes management and their pregnancy. This is merely an account of my personal experience when I was 0-13 weeks pregnant from April-July 2019, as a woman with LADA.

***

If you've been following my blog for awhile, you may recall that I got pregnant last summer, but that it unfortunately ended in miscarriage in September 2018. And if you read this post you may also recall that one of my biggest stressors during those four weeks that I knew I was pregnant was managing my blood sugars.

Because I have LADA (latent autoimmune diabetes in adults - which you know all about if you read this post), my pancreas is malfunctioning like a Type 1 diabetic... but much more slowly. That means my diabetes has been relatively easy to control so far, requiring very little insulin. It also means that when I got pregnant for the first time in 2018, I only had a prescription for basal insulin - I had no access to fast-acting insulin that many diabetics take with meals or to correct high sugars.

My regular endocrinologist refused to see me when I was pregnant, wanting me to see MFM doctors and nurses instead (Maternal Fetal Medicine, where all patients with "high-risk" pregnancies are sent). Yet my OB wouldn't refer me to MFM until my pregnancy was proved viable. Unfortunately, that first pregnancy never would be - the ultrasound technician at my 6 week ultrasound thought maybe there was a fluttering heartbeat, but not enough to officially measure. And at my 8 week ultrasound I was told I was having a missed miscarriage. I'd finally managed to schedule an appointment with MFM for when I would be 9 weeks pregnant - but ended up having to cancel it and get a D&C that week instead.

I had a lot of questions about how to manage my diabetes when I was pregnant that first time, and was very frustrated when no medical professional seemed willing to give me advice, let alone a prescription. I was told that it was super important to keep my blood sugar under 90 for fasting, under 100 before meals, and under 120 for two hours after eating - but not given any resources to help me stay within those targets. I had only my basal insulin to work with, and to keep my blood sugars within the desired range, I ended up eating fewer carbs than my pregnant self wanted to.

So one of the first things I did after my D&C was schedule a new appointment with MFM. I knew we would want to try to get pregnant again as soon as possible, and I wanted to be more prepared before I got pregnant again. I saw MFM in October 2018 for a "pre-conception consultation," where we discussed my miscarriage, my diet plan, and what I should do next time I became pregnant. I also took their advice and got a CGM - continuous glucose monitor - which I began wearing in early November. I saw my regular endocrinologist as well (who would see me again, now that I was no longer pregnant), and while he still didn't prescribe me mealtime insulin, he did give me several sample pens to take as needed.

These samples were Humalog and Fiasp, and I used them only if I was already at 120 or so before eating a meal, at which point I'd take 2 u. or 3 u. when I ate. To be honest, I felt bad using them, because it felt like such a waste of insulin. Once you start using an insulin pen, it only lasts 4-6 weeks (depending on the brand/type) before it expires and has to be thrown away. During those 4 weeks, I would only use maybe 10 u. of the 300 u. in the pen, and the rest of the 290 u. would end up in the trash. As a result, if I didn't already have a pen in use, I often let a higher pre-meal blood glucose slide, because I didn't want to start another pen if I didn't "have to"; conversely, if I already had a pen open and it was nearing its expiration date, I'd be quicker to use a bit of mealtime insulin - because at that point, I might as well, since it was about to go to waste if I didn't.

In the end, I did appreciate having those pens. They gave me peace of mind when I had to get through those first several weeks of pregnancy by myself, before seeing MFM. I didn't use them often, but I knew I had them on hand to use if I saw my numbers start to creep up too high (like the scary 300 I saw after my D&C in September), and just knowing that I had them was reassuring.

All of this is to say that I definitely felt more prepared going into my second pregnancy than I did my first - at least where my diabetes was concerned. I knew that I wouldn't get in to see MFM in person until around 8 weeks or later (after fetal viability had been proved) - but I'd also gotten a chance to meet MFM already, and had contact information for some of the nurses and doctors in case I had any questions before that 8 week appointment. (And I did email them a couple times.) I also had access to mealtime insulin if I felt like I needed it. I was still worried about others things during those early weeks (which I've already covered in this post) - but this time around my diabetes wasn't one of them.

I wasn't always under 120 after meals - but I was usually under 140, which I thought was impressive (especially given that I was eating 40-50 g of carbs per meal, instead of the 30 g I'd been eating a few months prior). In fact, my A1C just before I got pregnant was 5.5%, which is below the pre-diabetes cut-off of 5.7% and a great place to be at during pregnancy.

This time, my pregnancy was deemed viable at 5 weeks 4 days, when my first early ultrasound showed a heartbeat of 101 bpm. Because they also found a cyst on my right ovary (a common and benign occurrence, happening in about 10% of pregnancies), they had me return for a follow-up ultrasound a week later, at 6 weeks 5 days, to keep an eye on the cyst. With everything with the baby still looking good, they sent a referral to MFM for me at that point. I scheduled my first appointment with MFM for when I was 8 weeks 4 days pregnant.

That first appointment with MFM was a LONG one. I was there for more than two hours. First, I had an ultrasound - with better equipment than my regular OB office. (The best perk of being considered "high risk" - which all diabetics are - is that it means more ultrasounds, and more chances to see my baby-to-be in utero!) I received four pictures from the ultrasound, two of which were 3D images.

The photos from my MFM ultrasound at 8 weeks 4 days. The top two are 3D images, and the bottom two are typical 2D sonograms. The little donut-shaped piece hovering by the baby-to-be's head is the yolk sac, which nurtures the baby during the 1st trimester until the placenta forms.

The rest of that first appointment was all about my diabetes - how often I should be eating (3 meals + 3 snacks, for a total of 6 times a day - or about every 2-3 hours), how many carbs to eat (50 g for each meal and 15-20 g for each snack), and what my new insulin regimen should look like now that I was pregnant with a "viable" pregnancy (finally a real prescription for mealtime insulin!). Before I left, I talked to a doctor, a nurse, and a nutritionist.

I was told that typically insulin resistance gradually increases throughout pregnancy, which would mean I would need to take more and more insulin as time went on to maintain good blood sugars. Initially, they decided I should keep my basal insulin doses the same as they were pre-pregnancy (5 u. in the morning + 7 u. at bedtime), but add an additional 2 u. of mealtime insulin with lunch and dinner (the two meals where I was more likely to end up above 120 two hours after eating).

Over the course of the next several weeks, I called my blood sugar logs into the MFM nurses' office twice a week, so they could assess and make further adjustments to my insulin. By the time I was 11 weeks pregnant, I was taking 2 u. of mealtime insulin with breakfast as well, and had seen my lunch and dinner mealtime insulin each increased to 3 u. My morning basal insulin was also increased, to 6 u.

My nighttime basal, however, was lowered - first to 6 u., then to 5 u., then down to 4 u., then back up to 5, and back down to 4 - over the last few weeks of my first trimester. I kept having hypoglycemia overnight, and unfortunately lowering my evening basal dose didn't even seem to help. Instead, I was told to just "eat more carbs." Meal recommendations were raised to 60 g. of carbs, and my bedtime snack was raised to 25 g., then 30 g.

One of the tropes our society loves to say about pregnant women is that they get super hungry and eat a lot of food (and in strange combinations). While I'm sure that's true - especially by the 2nd and 3rd trimesters - it's often not true during the 1st. I was one of the lucky ones that didn't get any morning sickness or nausea to speak of - but that didn't mean I was feeling 100% all the time. I usually felt okay in the morning, and was often hungry for breakfast, lunch, and mid-morning snacks (especially by the end of my 1st trimester). But after dinner most days I felt full and bloated and exhausted. All I wanted to do was go to bed - not shove 30 more g. of (healthy) carbs in my face after I'd already eaten 220 g. earlier that day.

There were days when it felt like all I did was eat - not because I was hungry, but because I was on a schedule or because I was afraid my blood sugars would go too low. I read a book titled "The Girls at 17 Swann Street" during this trimester, which was about a woman with anorexia who was at a residential treatment center - and I related far too much with the main character, who was "forced" to eat six meals a day of carefully portioned amounts of calories, even when her body (or brain) didn't want to. Planning what to eat, and having to eat it all, sometimes felt like a chore.

My average daily calorie intake around 11-13 weeks pregnant was 2100-2400, which was more in line with what doctors often recommend for the 2nd trimester - not the 1st. When I started to "show" a bit as early as 10 weeks, I didn't know if that was normal for someone with my body shape, or if I was just putting on too much weight too soon. (I worried that it was the latter.)

Yet when I asked MFM if I was eating too much, they told me to eat even more. "Don't worry about the calories - just make sure you're eating enough carbs so you don't go low. That's what's more important." As if I could increase carbs without increasing calories too; as if eating more was the only option to avoid hypoglycemia. But every time I brought up the suggestion that we could cut my insulin instead - just for a couple weeks, while I was still in the first trimester and my insulin needs were still lower - they pointed to my slightly-off-target 130s after the occasional meal, and said that they didn't want to lower my insulin because they had to "balance the highs and lows" of my blood sugar.

It was very frustrating, to put it mildly - and eventually, I stopped asking and just started doing. I took 4 u. at bedtime even when the official recommendation was still 5 u. Other times, I took only 2 u. with dinner, if I was already in the 70s (or lower) before eating. I was up front about what I was doing - and sometimes they ended up agreeing with my self-prescribed doses, and changed the official recommendation to match what I was doing.

During my pregnancy's early weeks, I had low blood sugars about once a week on average. This was still more often than I'd like, but it felt relatively manageable - as long as my CGM (a Dexcom G6) was working well enough to alert me when I was going low. Unfortunately, that was not always something I could count on. Even before pregnancy (and in those first 4 weeks of pregnancy, before I got my positive test and knew I was pregnant), I had some issues with accuracy. There were several sensors that ended up waking me up in the middle of the night, claiming I was low when I wasn't. By the time I was 9 weeks pregnant, however, my sensors weren't just inaccurate - they'd completely stopped working. I would try to recalibrate them when I saw I was getting drastically different readings than my meter, and instead of adjusting to the calibrations the sensors would simply shut down on me. One gave me the error message "sensor failure" after only 6 days of use (when they're supposed to last 10); the next gave me that same error only two hours after I'd started it.

I used to always feel symptoms when I experienced hypoglycemia - even if my meter claimed I was only at 72 or 75 (when the typical cut-off for mild hypoglycemia is 70). I would get really warm and sweaty, my heart would feel like it was pounding in my chest, I'd feel anxious and panicky, and I'd be so physically weak and shaky that I had trouble unwrapping individually packaged Life Savers to treat my low (which is why I started stocking up on Smarties candies instead - the twist-open packages were much easier to get into). But after only a few weeks of being pregnant this time, I started having "hypoglycemia unawareness" - meaning I would keep sleeping until my CGM woke me up with its "urgent low" alarm when I was at 55 or below. And even then, as I sat up and opened candy wrappers and ate my snack, I never felt any symptoms.

On the one hand, it was kind of nice not to feel horrible and like I was about to die, just because my blood sugar was a bit low. But on the other hand, it was scary that my body was so unaware - especially as my CGM got less and less accurate, and started downright malfunctioning. If my body can't tell when it's going low, and neither can my CGM (because it's not sensing or transmitting any data at all) - what would happen if I continued to fall past 54 (moderate hypoglycemia) or past 40 (severe hypoglycemia)? I might not feel like I was about to die anymore - but I'd be more like to actually die. Untreated hypoglycemia that continues to fall past 40 can result in unconsciousness and death.

The Dexcom G6 is technically not approved for pregnancy - because it was never officially tested on pregnant people. That said, a LOT of pregnant people use it, and my MFM doctor encouraged me to continue wearing it. It's also not technically approved to be worn anywhere other than the abdomen or the upper buttocks - again, because those are the only locations they tested it on, not because they're the only places where it will work. As long as there is ample subcutaneous fat tissue for the short, thin needle to be inserted into, any location will (theoretically) do.

I was already experiencing enough bloating by 8 weeks pregnant that I thought maybe my expanding (and shrinking, and re-expanding) abdomen was becoming a less-than-ideal location for my sensor, with my bloat causing some of the inaccuracies I was seeing. By 10 weeks pregnant it was even worse - now that I was taking insulin 5 times a day, my abdomen was dotted in a dozen small bruises from needle injections. My torso is short as it is (all my height is in my legs), and there's not a lot of room to work with between my ribs and the waistline of my pants, especially given that I have to also avoid the scars from my appendectomy 18 years ago (since the sensors won't work through scar tissue). Trying to avoid my insulin bruises, and find a spot that wasn't totally uncomfortable on my bloating pregnant belly, were two more limitations too many. Even if my CGM had been accurate on my abdomen (which it no longer was), it was definitely no longer comfortable.

At first my MFM doctor didn't think I had enough fat on my arms, but eventually he agreed that maybe the back/underside of my upper arm would work and gave me the go-ahead to try. It's a bit of an awkward place to insert (I either have to look in the mirror, or have my husband insert it for me), but once it's in, it's loads more comfortable than it was on my abdomen. Even better, it was finally accurate again! The first sensor I wore on my arm was the most accurate I'd seen a sensor in a LONG time. It was still giving me very accurate readings even on the last day of the sensor session (day 10) - an extremely rare occurrence for me when I was wearing them on my abdomen.

During the last couple of weeks of my first trimester then, I no longer had to worry about my CGM being inaccurate and not catching overnight hypoglycemia. I even saw some of my symptoms return by 13 weeks, waking me up with clamminess and panic before I got low enough (55) for my CGM alert to go off - meaning I wasn't completely hypoglycemic unaware after all!

But worries about not knowing I was going low were only PART of the problem, and the other part - the hypoglycemia itself - was never truly fixed... at least, not during the 1st trimester. In fact, it only got worse. During the first 8 weeks of my pregnancy, I had hypoglycemia 7 times. During the last 6 weeks of the 1st trimester (the weeks after my first MFM appointment, when I started mealtime insulin), I went low 16 times - or about 2-3 times a week on average, sometimes seeing as many as 5 times in a single week.

Having that many low blood sugars is frankly exhausting. I was also getting up at least once in the middle of the night every night to pee, and having further sleep disturbances due to weird or bad dreams - things that are common 1st trimester symptoms, but which I suspect were exacerbated by me eating a few hundred calories (and drinking water with them) before bed every night in a rather futile effort not to go low.

All told, there were only 8 days during the first ten weeks I knew I was pregnant when I actually slept through the night (or at least slept well enough that I didn't make a note about waking up in the middle of the night on the daily symptom chart I kept). From 10-13 weeks pregnant, I didn't sleep through the night once. Many of those nights entailed waking up multiple times - at 1 am to pee, at 2 am because my CGM alert sounded and I had to eat a snack, and a third time at 3 am because I was now having a nightmare fueled by my post-snack blood sugar rise (including one particularly vivid and unforgettable nightmare that my dog was kidnapped, killed, and baked into a blueberry pie).

If you've never experienced overnight hypoglycemia, it might seem like a problem with a fairly awesome solution - get up in the middle of the night and eat candy. Isn't that what we all dreamed of as kids? But let me tell you, it really sucks. The last thing I want to do at 2 am is eat Smarties, wait 10 minutes to make sure my blood sugar is rising appropriately, and then eat a snack to make sure I don't go low again a few hours later. I end up getting graham cracker crumbs all over my pillow, and wake up with awful, gross candy-mouth. I even started getting out of bed and brushing my teeth after eating my snack, to see if that would help - but when I woke up four hours later to start my day, my mouth still felt disgusting.

But because my hypoglycemic episodes were all "mild" (between 54-70) or "moderate" (just below 54), my doctors didn't seem to take them seriously - not as seriously as I would've liked them to, anyway. They wrote me a prescription for a glucagon kit, an emergency injection to raise my blood sugar if I were to ever have a severe episode and be too weak or unconscious to self-treat with candy, and I made sure my husband read the directions so he would know what to do if my CGM alert starting going off in the middle of the night and I didn't wake up. I was even told on a couple occasions, by a couple different MFM doctors, that it was better and safer to have a few 130s after meals than to go low all the time. But then when it came to actually making decisions about my insulin regimen, they refused to follow their own advice. The general consensus in the MFM office seemed to be "we'll take your hypoglycemia complaints seriously when it's more serious. In the meantime, keep taking 19 total units of insulin a day, and eat more carbs."

This was not the only situation in which the MFM doctors would tell me one thing - and then request that I do something that went directly against what they said. It's like they wanted to treat me as an individual (a 30-year-old pregnant woman with LADA who had a terrific A1C)... but only so far. Then it was right back to their by-the-book instructions they followed for ALL diabetic patients, regardless of how well their diabetes was controlled, or how sensitive they were to insulin.

They told me that my 5.5% A1C meant I'd pretty much erased any higher risk for birth defects I might've had because of my diabetes, and that instead of a 5% chance of birth defects, I had only a 1-2% chance, same as any pregnant person in the general non-diabetic population. (By 13 weeks pregnant, my A1C was even lower - down to 5.1% - no doubt thanks to all those hypoglycemic episodes.) Then, in the next breath, the MFM doctors warned about all the third trimester complications my diabetes could cause - complete with the assertion that I would "probably be induced at 37-38 weeks, unless complications arose that required being induced even sooner." Excuse me? Can we WAIT and see what (if any) complications I develop first, before we just assume that I'll have to be induced so early??

Then, when I complained about orthostatic low blood pressure (black spots in my vision, lightheadedness, and headaches when standing up too quickly), I was at first told to increase my salt intake to raise my blood pressure a bit... and later during that same appointment that I would still need to start taking baby aspirin at 12 weeks, same as every diabetic patient, to prevent preeclampsia (a condition caused by high blood pressure). When I questioned this, they relented - but only so far: "Ok, maybe your chances of developing preeclampsia are closer to the general population's 7% chance than the typical diabetic's 30% chance... but it still won't hurt anything to take daily baby aspirin, so you might as well." When I asked if it would lower my blood pressure too much and cause me to have more orthostatic blood pressure issues, I was assured that it wouldn't, because it's not a blood pressure medicine. At my next appointment, however, I was asked if I had started taking baby aspirin yet, "to lower your blood pressure." I just wish all these doctors could get their stories straight!

On the plus side, my second appointment with MFM came with another ultrasound (my 4th overall), at 11 weeks 4 days. I got several more sonograms to take home from that appointment - including one where the baby kicked its leg out, and another where it waved its arm! I suppose getting to see the baby developing, and receiving so many souvenir photos to take home, makes up for all the other hoops MFM was making me jump through. ;)

Photos from my MFM ultrasound at 11 weeks 4 days. The middle picture on the right is where the baby kicked its leg out, and the far bottom right picture shows a hand waving.

In addition to all these "typical" doctors visits, MFM also ordered several labs and tests for me to establish a "baseline" of my kidney and heart function, so that there would be something to compare to during the third trimester, if any complications were to develop. (My insurance only covered some of the tests. Apparently "preventative care during pregnancy" wasn't covered for the first 180 days of starting a new insurance policy, and many of my MFM visits fell under that category.)

I had to do a 24-hour urine collection to check for protein spillage (an early sign of preeclampsia), which meant I was stuck at home all day peeing into a plastic bowl resting on my toilet seat, and then pouring my urine into a large jug. I had to have extra blood work done, in addition to the standard tests my regular OB had already ordered. And I had an EKG (electrocardiogram) to check my heart.

Everything came back normal - except the EKG, which came back as "borderline." I was instructed to get a "2D echo" (echocardiogram, or heart ultrasound) as follow-up, to see whether the EKG's assertions of a "possible left atrial enlargement" and "incomplete right bundle branch block" were true. Three weeks later (the earliest appointment they had), I finally had my 2D echo. Over the course of almost an hour, the ultrasound wand was repeatedly pushed - hard - into my chest. From what I gather, that's pretty typical of an ultrasound of your internal organs (my husband has had a few kidney ultrasounds, and attests that they push the wand really hard into his back during those as well) - but it's even worse when the area they're pushing on is sensitive, tender, and sore, and had been for the past eleven weeks, as my breasts started going through normal pregnancy changes.

Thankfully, the results of the 2D echo came back as normal, meaning the EKG's results were yet another false red flag - the third I'd seen during my first trimester. (The first was when my regular OB worried that my perfectly normal corpus luteum ovarian cyst was actually a super rare heteroectopic pregnancy - a twin that had implanted in my fallopian tubes instead of next to the viable pregnancy in my uterus - until my ultrasound with MFM at 8 weeks 4 days finally proved that it was not ectopic, and only a cyst. The second was when a different doctor at my regular OB office thought she felt a lump in one of my breasts, necessitating a breast ultrasound to verify that I was indeed cancer-free, with only normal breast tissue in both breasts.)

Needless to say, I had a LOT of doctor's appointments in my first trimester: early blood draws to check my hCG hormone levels (a precaution they took because my first pregnancy ended in miscarriage); additional blood draws in later weeks to check standard pregnancy assessments, test my A1C every month, and have a complete metabolic panel done; regular appointments with my OB office (and extra ones, while they kept an eye on that possible heteroectopic pregnancy that was really just a cyst); appointments with MFM doctors, nurses, and nutritionists to review my blood sugars, insulin doses, and food logs (as well as go over the many test results that were coming in from all the procedures they ordered); and the procedures themselves - three transvaginal ultrasounds, two transabdominal ultrasounds, a breast ultrasound, my initial EKG, and my heart ultrasound.

Altogether I had 15 appointments in the span of ten weeks. That's fifteen times I physically drove to the hospital, the hospital outpatient building, or my OB office - which is just around the block from the hospital. (I guess at least I'll know the layout of the entire hospital campus before I have to go there for labor and delivery, at this rate!) Additionally, my phone logs for those ten weeks show 45 phone calls back and forth with receptionists, OB doctors, MFM nurses and doctors, and medical equipment companies (to order more test strips and CGM sensors, or to report CGM technical errors).

Planning meals, eating six times a day (and making sure I ate the right number of carbs at the right time), taking insulin five times a day (and making sure I was doing so from the right type of insulin pen, and in the right dose), and going to all those doctors appointments was all a little overwhelming - and definitely time consuming. It was a lot to keep track of - especially when burdened with that first trimester exhaustion!

But I was also grateful to access to all of this (even if we did end up paying a bit more in out-of-pocket costs than we anticipated). Just a few short decades ago, a lot of this information about how best to control diabetes during pregnancy (not to mention many of those preventative and diagnostic tests) wouldn't have been available to me. I probably wouldn't have a CGM to help wake me up when I had low blood sugar overnight, either - which means they likely wouldn't have remained "mild" or "moderate" but turned into "severe" hypoglycemia. In fact, a few short decades ago, my LADA might not have even been discovered yet (or perhaps misdiagnosed as Type 2 instead) - and while that would mean more blissful ignorance (and less insulin), it would also mean my A1C would likely be closer to 6.2-7% going into pregnancy (if not even higher), which would set me up for a greater risk of birth defects or pregnancy complications.

Still, it's hard to be appreciative when you're tired and frustrated, and feeling micro-managed by an entire team of doctors (who don't always seem to have your best interests at heart)... Thankfully, the second trimester is supposed to be easier. Hopefully that means my diabetes management will be too!