A six-pound, nine-ounce bundle of original sin, I was doomed upon arrival. In my infantile state, I failed to realize the totality of my holy burden. According to the Catholics, I was responsible for the mistakes of Adam and Eve, people I’d never met. Until I was baptized, I risked an eternity in Limbo, and in my first wee weeks, I was forbidden to leave home. I didn’t object when the priest doused my naked head with his sanctified holy water, making my miniature soul safe. I stayed sound asleep while his whispered prayers washed away my affliction. And just to be sure of my salvation, a tiny crystal rosary was hung around my neck, forever tethering me to an unseen God.
My mother was the driver of Catholicism in our family, raised up in a cult-like Irish faith that she dared not question. On Sundays, she dragged my sister Kristen and me to St. John the Baptist, where, from a Gothic jewel-encrusted altar that served more to intimidate than to enlighten, the Word of the Lord was preached down upon us. Like my mother, we were taught to revere the priests and their sermons, our devotion shown in our silence. Forced to sit up at attention on the hard wooden pews, we also learned to stand, knee, and pray on cue. The Bible was an instruction manual—do this; don’t do that.
There was no wiggle room for females in the Church. I was boxed in by generations of rote narrative about a woman’s place before God and her husband. And truthfully, when I was young, I was excited by the prospect of my future as wife and mother.
I wore my first white-lace veil on a sunny Mother’s Day, when I made my first communion. With that sacrament, I was taught to share in the body and blood of Christ, to ingest His very essence, albeit in the form of a stale white wafer that clung to the roof of my mouth. His body entered my body, and, therefore, our bodies became one. Of course, the metaphysical message and the metaphorical cannibalism were beyond my seven-year-old comprehension; I was just thrilled to prance around the house as a baby bride-to-be.
I was indoctrinated in absolutes: the sole purpose of making love was for the conception that would create a pregnancy. My mom offered stern advice to her four daughters in sarcastic snippets: “Don’t go out, procreate, and come home.” As a young woman, I knew I was damned at every turn: damned if I had sex out of wedlock, damned if I used birth control to protect myself, damned if I became pregnant, and damned if I had an abortion.
I toed the Catholic party line through most of grade school, but by my teens, I had more questions than answers. At the mature age of fifteen, following my confirmation, the sacrament where I was made to promise that my belief and participation in Catholicism was of my own volition, I left the church. At the time, I failed to realize the mindset was already fixed.
• • •
Decades later, Harry and I, like all couples at the start of fertility treatments, were warned of the biological possibility of a multiple pregnancy. And, like most couples, we stayed focused on conception rather than what might come next. I imagine if every pregnant woman considered the multitude of known embryopathies—all the things that could go wrong—the human race would come to a screeching halt. To prepare my body to receive fertilized eggs, my beefed-up drug roster included Follistim and Repronex. Some evenings I shot three separate doses. I’d load the syringe pen with a glass vial of medication, similar to placing an ink cartridge in a writing instrument, screw on a disposable needle and dial the correct dose. I’d pinch together a chunk of belly or butt skin and insert the tip of the pen into my flesh, slowly squeezing the injection button on the cap to release the hormone into my bloodstream. Thanks to my fatty tissue, the injection was virtually painless. For better and worse, motherhood has an addictive pull. I just closed my eyes and injected.
At the end of the cycle, to minimize our risk of multiples we took a conservative approach. Based on our doctor’s advice, for my in vitro fertilization we replaced only three blastocysts back into my uterus.
Two weeks after my embryo transfer, I learned I was pregnant via a standard blood test. I was still giddy from the successful implantation when, at the week-five visit, following my first transvaginal ultrasound, the doctor announced twins. We privately celebrated our miraculous news for a week. Having twins was like hitting the fertility lottery—two for one and no more injections. The week-six ultrasound was supposed to be a follow-up, to check in on the twins’ progress. But to our shock, we had really hit the fertility lottery: I was actually pregnant with triplets.
“Let me tell you how rare this is,” the doctor said, as we sat huddled together, studying the ultrasound photos. Two of the three blastocysts had embedded, and then one of them had split naturally, into identical twins. “I recall only one case of mixed triplets prior to yours,” he added.
I couldn’t be sure whether he was trying to give us a warning or make us feel special. I stared at the film, trying to identify this new form. White strata blurred across a gray sky. Two black holes stared back at me. In the void on the right, I detected the faint outline of a single bubble. Taking a deep breath, I let my sight sweep over the screen, and as my eyes adjusted to the dark pool on the left, two distinct circles slowly surfaced.
“Triplets,” I exhaled. After so much trying, a pregnancy was hard enough to believe—but triplets? I scrutinized the picture for an impression, a hint, something to confirm that what I’d seen was not an optical illusion.
• • •
In the days following that appointment, Harry and I bickered in hushed tones, as if our unborn children could hear us. Driving in the car, or standing in the kitchen stacking plates, we’d start into it again. I was trying to figure out the logistics of caring for three infants, while the thought of three itself and the finances bogged down my husband. Harry’s linear approach to reason collided with my wider view of our future, and I resented him for it.
“Let’s take this slowly,” he would say, trying his best to maintain control.
We can’t take this slowly! It’s happening now—I have triplets. This instant, they are feeding off my body, drinking my worry. My blood screams through microscopic filaments, and in my veins, I feel the chill as three tiny heartbeats echo back.
I didn’t say any of this out loud, of course—why panic my husband further?
A week later, we were sent to see a perinatologist, an obstetrician who specializes in high-risk pregnancies. As the technician slid the slick paddle across my bare belly, his hand turned in delicate circles, trying to capture an image for the screen. After a few silent pirouettes, he clicked off the machine, and the exam room went dark.
“If you wouldn’t mind staying put,” he said, “the doctor likes to review the images before you get up, in case he needs to check something again.”
Harry stood next to me, his hand spread flat on my shimmering belly. “How do you feel?” he asked when we were alone.
The door cracked open, and a fluorescent shaft of light split the darkness. I squinted my eyes to the glow. As if stepping onto a movie set, a white-coated man emerged, his voice beaming. “Kelly, Harry—a pleasure to meet you.” He leaned toward me, as if I were an eager fan, and extended his hand. “We’re all set here. Let’s meet in my office. It’ll be more comfortable to talk there—I’m about to tell you guys some things that are gonna scare the heck out of you.”
• • •
The office was a small meeting room with a round maple table and a few cushioned chairs. Harry and I pulled together as close as possible—arms entwined as we braced ourselves for our lecture. We were alone for only a few minutes before the doctor joined us.
Dr. Libron* was clean-shaven with dark brown eyes. His manner was friendly, almost easy-going, as he dropped his folder on the table to pull me out of my chair and embrace me. His hug was full-bodied, familiar, the way some fathers might hug their daughters. But my father had never hugged me like that, so I was a bit shocked at his immediate tenderness. I came to believe it was Dr. Libron’s way of giving me his physical support, letting me know I could lean on him, even before I realized I had to.
As he explained the wonder of embryogenesis happening inside my body, I realized that the creation story I learned when growing up left out the vital details. In sac A, I had seven-week-old monochorionic diamniotic (MoDi) identical twins. My embryo had split late following fertilization, resulting in their shared placenta, and it would be better if each of the babies had its own placenta—I think I heard this. Already, we spoke of the twins as a unique entity, a pregnancy unto themselves. In effect, they were.
On the other side of my womb was sac B, with my fat, happy eight-week-old singleton. With his own placenta, in his own space, he was developing blissfully, unaware of his complicated siblings falling behind in their development.
“I’m concerned about the lag time in gestational age,” Dr. Libron said. “A shared placenta presents certain risks for a disproportionate blood supply.” He explained that my pregnancy was in danger of twin-to-twin transfusion syndrome (TTTS), where the twins’ circulatory systems could fuse together as they developed. “There are specialists . . . prenatal surgery.”
I drifted in and out of the conversation, grasping at threads of the discussion. I tried to take notes. But the words were heavy and awkward. There was no effective way for me to stay wholly present and absorb the magnitude of what was being explained—a shared placenta and neonatal surgery and selective reduction, never mind the likelihood of miscarried babies. I understood that he was talking about my body, but this wasn’t supposed to be my pregnancy experience.
Just look out the window, I urged myself, studying the kernel-like buds on the cherry tree across the lawn. Harry pressed my hand if I seemed to be gone for too long, or perhaps he was holding on for dear life.
At that moment, I couldn’t comprehend the abnormal characteristics of my triplet pregnancy. All I heard was that the twins would most likely die.
“Go home. Think about your options. You have time to decide your next steps.”
Harry gripped me under my arm and steered me toward the door. I made it halfway to the parking lot before my legs buckled, and I slid straight down onto the sidewalk. My arms never left my sides to brace my fall. It was as though I’d collapsed from the inside out.
• • •
My faith had taught me that human life begins at conception. My religion had warned me that terminating a pregnancy is murder. As a single adult, I tried to embrace my sexual independence and move away from this archaic and guilt-ridden dogma. I thought I had. But facing the microscopic reality of fetal development, I came to see those learned beliefs were as ingrained in my psyche as cellular division was rooted in my body.
To say my pregnancy was closely monitored would be an understatement; after the triplets presented, I had five separate doctor’s appointments in four weeks. In the beginning, I’d foolishly assumed I had a typical age-related high-risk pregnancy, not realizing that I was part of an elite group. The .03 percent. Less than .03 percent of all pregnancies—fewer than three in one thousand—will result in MoDi mixed triplets. And of that number, a scant 7 percent develop TTTS. My twins had TTTS. I’d been too naive to know who Dr. Libron was or what a visit to his office meant when I was referred to him. As Chief of Staff of High Risk Maternal Fetal Medicine, Dr. Libron’s specialty is a side of reproduction we don’t often see: the thousands of women each year with high-risk pregnancies, and those couples who leave the maternity unit empty-handed.
I found no comfort when the doctor presented the various scenarios. It was possible—though, he emphasized, unlikely—that I could carry all three babies to term. I obsessed about a late-term miscarriage, envisioning fully identifiable body parts spilling from my womb, or a delivery that would last hours, only to end with my birthing three lifeless clumps.
If it were just the twins, my options would have been different. I could have opted for laser ablation surgery, a high-risk maneuver completed in utero. A laser would be used to sever knotted veins, tangled arteries, and other twisted bits and—the hope was—keep them independent. But it wasn’t just the twins, so my choices for surgery and intervention after 12 weeks were limited. I could watch and wait and pray that the developmental damage to the twins was limited and sac B remained safe. But what if my healthy fetus in sac B was damaged during an invasive intrauterine surgery?
It was also likely that the twins, if they survived, would suffer life-threatening abnormalities; I was petrified by the lack of control I would have over my children once they left my body. (As if I had control of the pregnancy itself.) Could I knowingly and willfully give birth to biologically malformed infants, only to surrender them to a world where medical intervention would be their only means of existence?
And what about my singleton? How could I be a full-time, dutiful mother to his needs when my attention would understandably be focused on his siblings?
Then there was the inconceivable option. I could surgically drown the twins in their sac and try to keep the singleton. I had until the week-twelve mark to decide; if I elected to carry past the week-twelve mark and the pregnancy began to falter, fetal reduction would no longer be an option. Unable to discern the healthy fetus in sac B from the dying ones in sac A, my uterus would naturally and spontaneously abort the entire contents of the womb. The babies would go out with the bath water, as Dr. Libron put it.
I became fixated on my singleton, imagining my fat, happy bean suddenly ambushed by the unhealthy biological behavior of his siblings. When my body prepared to terminate, would he feel the rupture of being hastily torn from his tender nest? The sensation of pain as it stung his blossoming nervous system? I pictured his independent circulatory system, blood surging through his miniature veins, and then abruptly ceasing to flow as the blood tide shifted and washed him from my uterus.
Lost in a space where many women find themselves, I was haunted by these emotionally difficult questions—the ones few are willing to ask, though so many are quick to judge the women who dare. Who speaks to a woman about such things? Who warns her of the horrors of creation? Who listens when she needs to speak honestly about what is happening in her body? I deliberated over every aspect, stewed in it for weeks—mostly alone.
In my attempt to cull reputable medical research, I spent hours weeding through the politically and religiously motivated twaddle on the Internet. Frustratingly, there was little information to be found about TTTS. I dug for a definitive answer, seeking reassurance that my triplets could survive to term. But I did not uncover one personal report of a successful MoDi pregnancy with mixed triplets.
My therapist offered even less help. “Do you have a God whom you can ask to help you decide what to do?” she asked. But even after so many lapsed Catholic years, I knew my God’s answer. Conception was at His hand, not mine. Who was I to engage in the forbidden practice of assisted reproductive technologies?
Despite the years I had been held hostage in the pew, my inner world was devoid of true spiritual guidance. My mother tried to offer what support she could about the triplets, but she lacked the words for the discussion. Her sorrow could be measured in silence and the miles between us. Whatever lay ahead—whether congenital disabilities or miscarriage or emotional suffering—was my cross to bear.
If it had been only the twins, I would have let biology take its course. But I had someone else to consider. It’s a monstrous amount of pressure to place on a helpless fetus or an expectant mother: the burden of choice.
How does a mother choose? How does she decide to sacrifice the possibility of life for two embryos to enhance the chances of success for another?
She waits—day by day, hour by hour, minute by minute, up to the very last possible second. She talks to her awaiting souls, using her hands to communicate, sending tranquil circular currents into her dark womb. She spins a tale, telling them how much they are loved and wanted. She stares hard and long into the cloudy screen, begging for a sign. And then she asks them for guidance and permission and forgiveness.
At the heart of my final decision was how best to preserve my healthy embryo. And in the end, I chose life.
• • •
I trudged through four weeks fueled by sorrow and exhaustion. In the long days between weekly ultrasounds, I cried constantly but willed myself to function. Each morning, I emphatically declared to the universe, I am a mother of triplets! I believed if I shouted it loud enough, maybe it would come true. But with each doctor’s visit, it was increasingly clear that TTTS was developing.
“How are we doing?” Dr. Libron asked, when we returned to his office in week twelve.
“I’m going to hell,” I answered. I wasn’t sure if I actually believed this, but the guilt took its familiar place upon my shoulders so easily. I was going to hell one way or another, trying to fulfill my ultimate purpose and become a mother. IVF constitutes a mortal sin by the Church, never mind reducing implanted embryos even if they are unfit for life.
But with my decision made, I focused on doing what needed to be done for my child.
The scene never leaves me. Even as I write this today, I feel as if it is happening at this moment.
I am on my back on the hard exam table. Again. Smith, the technician, has the ultrasound paddle firm on my abdomen. His eyes do not have their usual brightness, and he is not as chatty. He lost his mother this week. I know this because he’s scanned me so frequently. Despite his bereavement, he insists on being here, to see us through this part of our journey. I am thankful for his support and his skilled hand. Smith is familiar with my body, my triplets. He knows their development. An accurate reading on the ultrasound monitor is vital to the safe outcome of my pregnancy. Smith’s scan will guide the hand of the surgeon through the reduction. And today, we will grieve together.
Harry assumes his usual post along my right side and places his arm around my head. I think he fears touching my stomach or getting in the way. On the monitor, three little beans present themselves together for the last time.
“Will you zoom in as close as possible?” I pray for a last-minute clue that might change the prognosis. I watch the image of sac A enlarge. Two microscopic bubbles floating in one black pool. The twins are bigger now, almost two inches in length, and the heads are discernable from the torsos. Little arm buds are present, and at high magnification, they almost resemble the rough sketches of the Peanuts character Schroeder hunched over his piano, except lying down.
My untrained eyes search every millimeter of the frame for hope. But what does hope look like? If anything, this last look confirms what I have been told. One of the twins is visibly lagging in size behind the other. A stuck twin—that was the actual phrase the doctor used. It is as if she were shrinking, her partner becoming the obvious dominant of the pair. It is not the evidence I want, but it is an omen I will not ignore.
“Ready when you are,” Dr. Libron says.
I nod, and Harry kisses my cheek.
I am not afraid, even when I see the length of the syringe that Dr. Libron holds in his hand. Needles no longer scare me. The puncture is smooth, like a hot knife slicing through butter. The syringe piercing through my abdominal wall and deep into the uterine cavity feels as if someone is jabbing a finger into my belly. I am alert and attentive, my eyes fixed on the monitor. The procedure is mentally terrifying but physically painless. I watch the tip of the needle poke its way into sac A. The doctor’s thumb presses his instrument, and a thin stream of potassium chloride floods into me. I am caught in the current as the liquid fills each tiny fetus and the pulsating lights of two fragile heartbeats cease.
I know to some people it is as if I held the precious heads of my newborns under their bathwater. I battle that vision myself, but then I remember that where faith offers hope, biology is merciless. I would have never been handed any swaddled infants.
The four of us watch silently as the doctor gently pulls the syringe from my belly. There is no bleeding.
“Everything went very well. I’m optimistic,” says Dr. Libron.
Tears skirt sideways down my cheeks, a mixture of relief and panic. Now we wait. This is the hardest part of the procedure. We must wait eight minutes to confirm we still have a heartbeat in sac B. Harry cries, trying to hide his grief from me. We can be sad, I tell him. It is OK to be sad. Awkwardly, we hug each other. I am supposed to lie still.
The minutes pass. My abdomen is scanned a second time. I see Smith’s grin before the doctor says a word. We have a heartbeat. We have a heartbeat in sac B. I exhale so deeply I am dizzy.
The weightlessness I feel as we walk back to our car surprises me. Today, the bright sky doesn’t mock me, and I let the sunshine fill my face. For the first time in months, I’m not crying. I smile with relief.
“We are pregnant. We are going to have a baby,” Harry says, and hugs me closer.
“Yes, we are,” I answer, trying to believe him.
• • •
I’m mid-mascara at the bathroom vanity when my five-year-old peeks through the door and says, “Mom, imagine if there were three of me.”
Carefully, I put the wand I’m holding back into its tube and stare in the mirror. “Excuse me?”
“What if there were three of me? Sometimes I think there are three of me,” Deacon continues. Dressed in his racing car footie pajamas, he waits patiently for his answer.
“Then I would love all three of you,” I say, kneeling before him and hugging him to me, “and you’d need a bigger room.” I close my eyes and consider three Deacons running around my house, three pairs of rubber fireman boots lined up in the mudroom, three wet heads needing to be shampooed. He squirms as I hug him tighter, trying to squeeze the two other souls from his being.
• • •
My child was conceived by the skilled hand of an embryologist, under the watchful eye of a microscope. If our spiritual soul is a wholly separate entity from our earthly body, was this physically evident at my son’s beginning? Why did Deacon’s soul choose the one healthy body that embedded itself in me? What about the twins? Did their souls abandon their failing bodies before I intervened, or was there a celestial struggle for the lucky seat that reached its earthly destination? I am forever tethered to their unseen spirits.
• • •
It’s 2 AM when I hear Deacon call out from his bedroom. I wake so suddenly that by the time I get to his bedside, I’m chilled in a damp sweat.
“He’s here, Mom,” he says, eyes still shut tight.
“Who, baby? You’re just dreaming.” Bending down next to him, I gently kiss his brow. He’s sleeping soundly.
“Someone that is in this family is not in this family.”
“Sweetie, you’re dreaming.”
He opens his eyes wide, as if awake, and pushes himself up on his pillow. “No, Mom, someone that is in this family is not in this family.”
“What happened, baby? Tell me.”
“A dream I was having was ending, and someone called out to me, ‘Hey!’ It’s real, and he’s here. Here in my room. Someone said, ‘Hey!’ It’s not in my dream.”
“Was it a boy or a girl?”
“A boy—or maybe a girl. I couldn’t tell.”
“Did you say, ‘Hey,’ back?”
“No. I was scared.”
“Don’t be scared, baby. They just want to say hello.” I kiss him again and smile.
I trace the outline of his face with the tip of my finger, following the gentle slope of his nose over his soft little lips and up under his chin. After a few minutes, the soothing motion relaxes him. On me, it has the opposite effect.
I’m often wide awake, searching for signs in the shadows. And sometimes, in my son’s tender sleeping face, barely there—I catch a fleeting glimpse of the others.